Utility Sevice Request

Utility Service Application

* Indicates required field

Applicant 1 Name *

First

Last

App 1 Phone Number *

Social Security # *

Employer *

Date of Birth *

Employer Phone *

applicant 2 Name *

First

Last

Social Security # *

Date of Birth *

App 2 Phone Number *

Employer *

employer phone *

Service Address *

Line 1

Line 2

City

State

Zip Code

Country

If renting, landlord name *

Landlord Phone Number *

Reference Name *

Reference Phone number *

A deposit of $100.00 is required. Date deposit paid: *

I/We, hereby apply for utility services for the premises listed above beginning the __(DATE)___ pursuant to the rules and regulations of the City of Irwin provides weekly residential garbage pick up on Tuesday mornings. The City also provides weekly recycling pick up on Tuesday mornings. The utility bills are due the 15th of the month. A penalty is added if not paid on time. A grace period is given until the 25th at this time if bills are not paid they are subject to disconnection. a 24 hour notice will be posted on the door. After 24 hours, if no payment is made, the water will be disconnected and payment in full plus the $20.00 reconnection fee will need to be paid before service is restored. A customer will be given an opportunity to appeal the reason for discontinuance. Postponement of the shut-off is also possible. All appeals and postponements shall be a decision of the City Council.

I/We also agree to abide to the rules of the City of Irwin's Ordinances. Some of the rules in the ordinance states that grass should not be more than 6 inches tall, rubbish and garbage should not be in yards, vehicles that are not in working order or not licensed are not to be in yards or city streets. It is required that ice and snow are removed from sidewalks within 24 hours. If these requests are not met, the City of Irwin will have this done and bill the Owner and or Renter. If not paid the cost will result in discontinuance of services for a renter. For the Owner, the City would apply charges to the Property's Taxes. If you have any questions regarding services provided by the City or the City's Ordinances, please contact City Hall at 712-782-3337. A copy of Irwin City Ordinance is available for inspection at the City Hall or on the website.

I understand the above information and agree to accept the terms of the utility services and the rules of the Irwin City Ordinance.

By typing my full name here, I/We agree this digital signature takes place of a physical signature.

applicant 1 full name *

Applicant 2 Full Name *

Date *

Submit

If you would like to set up direct payment for services with the City of Irwin, please click HERE.

All applications can be completed by hand if you prefer. Please pick up the form(s) from City Hall.