Utilities ApplicationUtilities Application DownloadClick here to download the Utilities Application Click here to download the Automatic Payment Electronic Debit FormWILMORE UTILITIES SERVICE APPLICATIONApplicant Last Name, First, Middle (Print)*Date Service Requested* MM slash DD slash YYYY Date of Birth* MM slash DD slash YYYY Applicant Social Security Number*Service Address (Premise)*Driver’s License Number*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificMailing Address (If different)Home Phone NumberCell phone #*City, State, Zip*Work Phone Number & Extension NumberEmployer*Employer’s Address*Spouse’s name (Optional)Date of Birth (Optional) MM slash DD slash YYYY Spouse’s Social Security Number (Optional)Spouse’s Employer (Optional)Spouse’s Employer’s Phone # (Optional)Applicant’s Email* Spouse’s Email (Optional) Consent* I understand that I am responsible for all water usage at the property and I will pay all bills owed by me by the due date. I will abide by and comply with all ordinances, specifications, and regulations of the Wilmore Utilities System. I will continue to be responsible for same until my account is closed following the normal procedures of the Wilmore Utilities System. By my signature below, I acknowledge that I understand and agree with all of the above.Signature*Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY I hereby acknowledge that I am responsible for any additional fees that might incur during collection of the final bill.*Reset signature Signature locked. Reset to sign again (Initial)*The water system in High Bridge service area and the South East County service area has separate and higher water rate schedules, and the water lines in those areas are NOT designed or intended for fire protection.Remit to:Wilmore Utilities SystemDeposit amount: $150.00210 S. Lexington Ave.,Refundable after 5 yearsWilmore, KY 40390Or applied to final billCAPTCHA
