2. City of Bismarck Public Works Department
   Residential Utility Service Agreement
   
   The person filling out this form must be an Owner or Landlord

   
   

   Renters: Do not complete this form.

   If you are a renter who needs to have the utility account for a property switched to your name, the owner or landlord of the property is required to contact the Public Works Utility Billing Department to update the utility account with your information. Owners and landlords can call our office at 701-355-1700, option 1. Thank you.

4. Public Works Utility Billing Account Information
   Service Address (Physical address of house)*
5. 
   Closing Date*
   
   Closing Date
7. Name Requested on Utility Account*
8. E-mail Address*
10. Primary Phone Number*
11. Secondary Phone Number
13. Mailing Address
    (Location to receive Utility Bill if different than the service address)
15. City
16. State
17. Zip
19. Spouse or Other Owner Information
    Spouse or Other Owner's Name
20. 
    Spouse or Other Owner's Cell Phone Number
22. Spouse or Other Owner's E-mail Address
24. Emergency Contact
    (Other than aforementioned spouse or owner)*
25. 
    Emergency Contact Phone*
27. Relationship to Emergency Contact
29. Is this a newly constructed home in need of a garbage container?*

    1. Yes
    2. No
31. Agree to Terms*

    
    

    Residential 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 customer, a final reading of the water meter will occur. Utility billing begins when the water meter is picked up for newly built properties. It is agreed that the undersigned will be bound by the rules, regulations, policies, procedures, and ordinances applicable to the City’s utility systems and solid waste management. The undersigned must pay for all services used and rendered through the final reading of the water meter. Should the undersigned have an outstanding balance on a previous Public Works Utility Billing account, it is agreed that the balance will be transferred to this property for payment.

    
    

    Container Agreement

    It is agreed that the Public Works Department shall remain the owner of such containers and the property owner hereby agrees to pay the Public Works Customer Service Division the selected current monthly service fee for garbage collection and disposal. It is also agreed that the property owner shall indemnify and hold harmless the City of Bismarck from any and all claims of personal injury, property damage, or any other action arising out of the property owner’s use of the container and the City of Bismarck’s use of private driveways for the purpose of collecting garbage.

    
    

    1. Yes I Agree to the Terms of this Agreement
33. 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.
    
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field