Utility Customer Application

Administration & Finance
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Utility Customer Application

The following information MUST be provided to become a utility customer. Failure to do so may result in refusal of or termination of service.

The form below will not be considered complete until a utility deposit has been made in person at City Hall or over the phone by calling 402-643-2927.

If you would prefer to print out a form to fill out and submit with your deposit, click here.

Utility deposits will be refunded after 24 months with no late payments. The deposit will be applied to the balance due on the account. Any balance of the deposit will be refunded after the final bill is paid.

Utility bills are emailed/mailed prior to the 1st day of the month and are DELINQUENT AFTER THE 15TH DAY OF THE MONTH. A 10% late charge will be assessed to all bills received after the 15th. Payments can be made at City Hall, the drop box located in the alley south of City Hall, bank deduction or online.

Date of Service

Customer Name

First

Last

Service Address

Check One

Renter

Owner

Number of people living here

Please list landlord

Last 4 digits of Social Security Number

Phone

Phone Type

Home

Cell

Work

Employed by

Date of Birth

Please email my monthly utility billing to the listed email address

Yes

Co-Occupants, if different than listed above

Name

First

Last

Cell Phone

Work Phone

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