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2. City of Eudora Application for Utility Services
   Complete the online form below to submit your application. If you would like to contact us by phone, you may call (785) 542-2153.

   Please Note: We will require a valid driver's license number and/or social security number. A nonrefundable connection fee of $40.00 for electric service and/or $30.00 for water service is required with all applications before service can connected. Please allow one business day for services to be connected once the application has been approved.

   The undersigned hereby makes application for utilities at said premises. The undersigned hereby agrees to comply with all City Ordinances concerning utilities and to pay for services rendered at the City’s prescribed and approved rates.

   
   Account holder and/or recipient of services shall pay any and all charges related to the reasonable costs of collection of this account/service. The cost of collection include, but are not limited to, court costs, surcharges, attorney fees, and collection agency fee, except that such costs of collection may not include both attorney fees and collection agency fees. This is per Ordinance 1071 that was passed on November 13, 2017 and published November 16, 2017.

   
   By submitting this application, applicant(s) are signing this application electronically. Applicant(s) agree their electronic signature is the legal equivalent of their manual signature on this application. By submitting this application all applicants consent to be bound by the terms listed above.

4. Are you a landlord registered with the City of Eudora?*

   1. No
   2. Yes
6. Date:*
8. Service Start Date:*
10. Service Address:*
12. Name:*
14. Driver's License State:*
16. Spouse/Roommate Name:
18. Phone Number:*
19. Phone Type:

    1. Landline
    2. Cell
21. Email:
23. Billing Address (if different from service address):
25. If Renting, Landlord's Name:
27. Previous Address:*
29. Employer:
31. Employer Phone:
32. Years at current Employer:
34. Would you like information about the level payments program?*

    1. Yes
    2. No
36. Would you like to receive your monthly utility bill via the email provided above?*

    1. Yes
    2. No
38. Would you like text alerts regarding your utility bill to be sent to the phone number provided?*

    1. Yes
    2. No
40. Electronic Signature*

    1. I agree

    
    By checking this box, applicant(s) are signing this application electronically. Applicant(s) agree their electronic signature is the legal equivalent of their manual signature on this application. By checking this box and submitting this application all applicants consent to be bound by the terms listed above.

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field