Action Center / Customer Utility Card / Mulvane, Kansas

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The City of Mulvane supplies the electric, water and sewer in the city limits of Mulvane. New Customers moving in the city of Mulvane may fill out the Utility Customer Card below to set up their utilities. One working day is required prior to turning on utilities. Deposits are required on the electric and water services only. (See fees at below.)

If customer requires only one utility service, please indicate using the checkboxes for the electric and/or water utility you are requesting. Please remit the correct deposit for that utility. If driver's license or state identification does not accompany your customer card, a delay of service may result until we receive the necessary document. If you prefer, you may instead mail in a completed hard copy form available here.

Deposit Schedule	Sewer	Water	Electric	Total
Renting Customer	$0.00	$50.00	$100.00	$150.00
Purchasing Customer	$0.00	$25.00	$75.00	$100.00
Residential Commercial Account (For customers turning utilities on for a company or as a third party.) (For large commercial accounts please contact city hall for the deposit amount at 777-1143. This includes all business utilities.)	$0.00	$25.00	$100.00	$125.00

* Denotes a required field

Customer Utility Card

Please fill out the form provide with as much information as possible.

Electric Service

Yes

Water Service

Yes

Date*

MonthDay Year,

Full Name*

Service Address*

Mailing Address: (if different from service address)

Own or Rent

Own

Rent

If rented, name of landlord

By my selection below, I signify that I agree and understand the following: I am requesting the City of Mulvane to supply utilities and/or water at address given above and agree to use and pay for the services rendered and consumed at this address or any previous or subsequent address in accordance with the schedule of rates published for the class of service for which application is made. I further agree to conform to all the rules and regulations governing the service, and as the same may be modified or changed with the approval of said regulator body from time to time. I understand the City of Mulvane may discontinue service if I fail to pay when due any obligation I owe to the city for utilities furnished at any location.

Check Box to Agree

I Agree

Effective date of service*

MonthDay Year,

Account Holder Information

Primary Phone*

Phone Area Code-Phone 3-Phone 4 ext Extension

Alternate Phone

Phone Area Code-Phone 3-Phone 4 ext Extension

SS# or Tax ID*

SSN 1-SSN 2-SSN 3

Employer*

Work Phone*

Phone Area Code-Phone 3-Phone 4 ext Extension

Email*

Driver's License #

State of drivers license

Date of Birth*

Second Account Holder Information

Name

Cell Number

Phone Area Code-Phone 3-Phone 4 ext Extension

SSN

SSN 1-SSN 2-SSN 3

Employer

Work Phone

Phone Area Code-Phone 3-Phone 4 ext Extension

Other Emergency Contact

Contact Name

Relationship to customer

Phone

Phone Area Code-Phone 3-Phone 4 ext Extension

Please Do Not Complete The Following Field

Check box if you wish to receieve a copy of this form

Also send me a copy

PLEASE DON'T FORGET TO PAY YOUR DEPOSIT. SERVICE CAN NOT BE CONNECTED UNTIL IT HAS BEEN RECEIVED. GO TO ONLINE PAYMENTS AND CLICK PAY MISCELLANEOUS FEES. - THANK YOU

Click Submit when finished.

The City of Mulvane, Kansas

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Customer Utility Card

Customer Utility Card

Account Holder Information

Second Account Holder Information

Other Emergency Contact

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