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Tenant Utility Service Request

  1. City of Bismarck Public Works Department
    Tenant Utility Service Request

    The person filling out this form must be the Property Owner or Property Manager


    If you are a Renter, do not complete this form.
    Please have the property owner or property manager complete this form or contact the Public Works Utility Billing Department by calling 701-355-1700, option 1. Thank you.

  2. Tenant Account Information

  3. xxx - xxx - xxxx

  4. Address                                  City                       State                Zip

  5. Emergency Contact for Tenant:

  6. xxx - xxx - xxxx

  7. Property Owner Information:

  8. xxx - xxx - xxxx

  9. xxx - xxx - xxxx

  10. Address                                  City                       State                Zip

  11. Property Manager Information:
    (If Applicable)

  12. xxx - xxx - xxxx

  13. xxx - xxx - xxxx

  14. Address                                  City                       State                Zip

  15. Agree to Terms*


    Tenant Utility Service Agreement
    This agreement shall remain in effect and shall be binding until notice is given to the Public Works Customer Service Division by the customer of the termination of this agreement. Upon notice of termination by the owner or property manager, a final reading of the water meter will occur. It is agreed that the tenant will be bound by the rules, regulations, policies, procedures, and ordinances applicable to the City’s utility systems and solid waste management. The tenant must pay for all services used and rendered through the final reading of the water meter. If the tenant fails to pay the utility billing, per City Ordinance 11-02-02.4 the owner of the property shall pay the charges.

  16. Someone from the Public Works Utility Billing Department will contact you by telephone or E-mail.
    Contact will be made within 2 working days to verify this information.

  17. Leave This Blank:

  18. This field is not part of the form submission.