Set Up Commercial Service

Utility Services for Commercial Business

Must have 24 hr. notice

Company Name(Required)

Service Address(Required)

Street Address Address Line 2 City ZIP Code

Utility Service Start Date(Required)

Tell us what day you prefer your Nixa Utilities services to begin for this service address.

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Tax ID Number(Required)

Business Phone

Premises are(Required)

Owned

Rented/leased

Landlord Name(Required)

Landlord Phone Number(Required)

Billing Options(Required)

Paper

Electronic Draft from Bank

Both Paper and Email

Has your business had prior service with Nixa Utilities

Yes

Address of Previous Service(Required)

Street Address Address Line 2 City ZIP Code

Main Contact Person

First Middle Last

Address

Street Address Address Line 2 City

Phone

SSN

DL Number

Conditions of Service

1. Applicant will 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. N. I have read the above stated conditions of service and request utility service under those conditions.

Applicant(s) Signature(s)

Date

Signature

Date

Witness

Date

Account Number

Phone

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

11286