Set Up Nixa Utilities Services for New Residential Customer

Residential Service Application

Complete and submit this form to set up new Nixa Utilities services at your residence.

Property/Service Information

Date Service Requested (Must have 1 full business day notice)(Required)

Service Address (Location to Receive Utility Services)(Required)

Street Address Address Line 2 City ZIP Code

Property is owned or rented?(Required)

I own this property

I rent this property

Is this address newly constructed? (No previous resident)(Required)

Yes, I am the first resident of this address.

No, this address is not newly constructed.

Does this address have an irrigation system?(Required)

Yes

Unsure

Does this address require gas service?(Required)

Yes

Nixa Utilities does not provide gas service. Please call Spire Energy to set up gas service: 1-800-582-1234.

Customer Information

Name(Required)

First Middle Last Suffix

Phone(Required)

Enter Email Confirm Email

If you opt-in for the Nixa e-Newsletter, we will send you a “Welcome to Nixa” email with info about our community (designed especially for anyone new to Nixa) and you will also begin to receive the official monthly email newsletter of the City of Nixa with information about upcoming events, important alerts, and other updates about your local government and community.

We also recommend you download the Smart911 app to sign up for emergency alerts to your phone or email. This service is provided free of charge by the Christian County office of emergency management.

Opt-In for Nixa e-Newsletter(Required)

Yes, sign me up for the Nixa e-Newsletter.

No, I don’t want important information about Nixa sent to my email.

Have you ever had service with Nixa Utilities before?(Required)

Yes

Previous Service Address

Street Address Address Line 2 City State ZIP Code

Full Mailing Address (if different from service address)

Street Address Address Line 2 City State ZIP Code

Applicant's Driver's License Number

Attach a copy of your driver's license(Required)

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 10 MB, Max. files: 2.

Maximum size allowed: 10 MB Maximum number of files allowed: 2

Applicant's Social Security Number

Applicant's Date of Birth (must be over 18)(Required)

Employer Name

Employer Phone

Emergency Contact

First Last

Emergency Contact Phone

Complete the following for anyone over 18 years old living at the service address other than the applicant

Adult Resident 2

First Last

Adult Resident 2: Social Security Number

Adult Resident 2: Driver's License Number

Adult Resident 2: Phone

Adult Resident 3

First Last

Adult Resident 3: Social Security Number

Adult Resident 3: Driver's License Number

Adult Resident 3: Phone

Adult Resident 4

First Last

Adult Resident 4: Social Security Number

Adult Resident 4: Driver's License Number

Adult Resident 4: Phone

Conditions of Service

1. Applicant will complete the above information in full and comply with and be bound by the rules and regulations of City of Nixa. 2. Disclosure of falsified application will be reason for discontinuation of service and additional deposit. 3. Nixa City Utilities or its third-party collectors will have the right to contact the customer’s employer for the purpose of collecting unpaid bills. The customer will pay all expenses, including reasonable attorney’s fees associated with collection of utility bills. 4. The customer will not be allowed to obtain utility service under a different or new applicant unless all delinquent accounts of the applicant(s) are brought current. 5. The customer may terminate the service obtained under this application by appearing at the office of Nixa City Utilities or by telephone upon furnishing Nixa City Utilities requested information. 6. Only persons listed on this application will be allowed to arrange disconnection, reconnection, or termination of service. 7. Customers that tamper with their meter and/or receive service without the City’s permission will be prosecuted. I have read the above stated conditions of service and request utility service under those conditions. I understand that by typing below in the “Digital Signature” field, I am digitally signing this document. My submission is not complete until I click “Submit” at the bottom of this form.

Signature

Comments

This field is for validation purposes and should be left unchanged.

Set Up Nixa Utilities Services for New Residential Customer

Transfer Utilities Service

Residential Service Application

Property/Service Information

Customer Information

Complete the following for anyone over 18 years old living at the service address other than the applicant

Conditions of Service

Utilities

Department Contact