Water Works & Lighting Commission

New Address to Begin Service

Please verify if you are the current owner, landlord, or tenant:

Owner

Landlord

Renter/Tenant

Service Address:

City:

State:

Zip Code:

Apt. or Mobile Home #:

Billing Address:
(if different from Service Address)

City:

State:

Zip Code:

Apt. or Mobile Home #:

Date Service is to Begin:
(previous dates will not be accepted)

Current Address to Terminate Service

Please verify if you are the current owner, landlord, or tenant:

Owner

Landlord

Renter/Tenant

Service Address:

City:

State:

Zip Code:

Apt. or Mobile Home #:

Billing Address:
(if different from Service Address)

City:

State:

Zip Code:

Apt. or Mobile Home #:

Date Service is to End:
(previous dates will not be accepted)

Water Works and Lighting Commission reserves the right to require a signed application for utility service. Customer will be subject to current rates, rules and regulations as set in our tariffs approved by the Public Service Commission of Wisconsin. You are responsible to notify WW&LC when you vacate to end billing at the property. You are liable for all charges incurred until the end date of services. You are also required to provide WW&LC with any changes to contact information.

CONSENT TO DISCLOSE ACCOUNT INFORMATION TO LANDLORD (OR DESIGNEE):

I UNDERSTAND THAT BY Wis Stat. my Landlord is given my account balance upon request. I do understand that no personal information will be shared at any time.

Responsible Party #1:

I consent to WW&LC to share billing & payment information with:

Signature if submitting information for your tenant:

Please know WW&LC will send your tenant a notification letter of service in their name.

All information provided will be confidential. False information can be cause for disconnection per the Wisconsin Public Service Commission rule PSC 113.0301. Residential service may be disconnected or refused for:
(i)Failure of an applicant for utility to provide adequate verification of identity and residency, as provided in sub.(3)

Commercial Request to Begin or End Utility Service

PLEASE COMPLETE ALL INFORMATION CLEARLY
Incomplete applications cannot be processed.

New Address to Begin Service

Current Address to Terminate Service

Business Information

CONSENT TO DISCLOSE ACCOUNT INFORMATION TO LANDLORD (OR DESIGNEE):

Landlord Section (if submitting application for your tenant)

Commercial Request to Begin or End Utility Service

PLEASE COMPLETE ALL INFORMATION CLEARLY Incomplete applications cannot be processed.

New Address to Begin Service

Current Address to Terminate Service

Business Information

CONSENT TO DISCLOSE ACCOUNT INFORMATION TO LANDLORD (OR DESIGNEE):

Landlord Section (if submitting application for your tenant)

PLEASE COMPLETE ALL INFORMATION CLEARLY
Incomplete applications cannot be processed.