2. Please note: Two business days advance notice are required to schedule a final reading.

4. Residence Type
   -- Select One --BuyingRentingNew Construction
5. Date of move in reading:

   (Monday - Friday Only)

9. This section is for RENTALS ONLY

11. Landlord or Apartment Manager Name
13. Landlord Phone Number
14. Landlord email
16. Landlord Address
17. Landlord Apt #
19. City
20. State
21. Zip
23. Is this a commercial account

    1. Yes
    2. No
24. Fed ID#
28. Address where Service(s) are to be provided
29. Apt #
31. City
32. State
33. Zip
35. Mailing Address if Different from Service Address
36. Apt. #
38. City
39. State
40. Zip

42. The information below will be used to document the person(s) responsible for this utility account and any others authorized to make changes to the account. 
    
    Primary Legal Name responsible for bill (Use Business name if commercial)

44. First Name
45. Last Name
47. Cell phone number
48. Home Number
49. Work Number
51. email

53. Other Name(s) authorized on the account to make inquiries or changes

55. First Name
56. Last Name
58. Phone Number
59. email
63. Do you currently have service with the Village of Little Chute?

    1. Yes
    2. No
65. If yes, Address Moving from:

    Address, Street

67. Do you need a final reading?

    1. Yes
    2. No
69. If yes, Date of reading

    Monday - Friday only
    Please note: Two business days advance notice are required to schedule final reading 

71. Submit*

    1. I agree

    By Submitting this form I certify that the above information is mine and all statements on this form are true and correct.

73. First Name
74. Last Name
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field