Utilities Application

Utilities Application Download
Click here to download the Utilities Application
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WILMORE UTILITIES SERVICE APPLICATION

Applicant Last Name, First, Middle (Print)*
Date Service Requested*
Date Format: MM slash DD slash YYYY
Date of Birth*
Date Format: MM slash DD slash YYYY
Applicant Social Security Number*
Service Address (Premise)*
Driver’s License Number*
State*
Mailing Address (If different)
Home Phone Number
Cell phone #*
City, State, Zip*
Work Phone Number & Extension Number
Employer*
Employer’s Address*
Spouse’s name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Spouse’s Social Security Number*
Spouse’s Employer*
Spouse’s Employer’s Phone #*
Applicant’s Email*
Spouse’s Email*
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*
Date*
Date Format: 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.*
(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 System Deposit amount: $150.00

335 East Main Street Refundable after 5 years

Wilmore, KY 40390 Or applied to final bill
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859-858-4411

859-858-4412

859-858-3595

Utilities Application

Utilities Application

WILMORE UTILITIES SERVICE APPLICATION

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Remit to:	Wilmore Utilities System	Deposit amount: $150.00
	335 East Main Street	Refundable after 5 years
	Wilmore, KY 40390	Or applied to final bill