Todays Date

Tenants Full Name

Your Email

Date Of Birth

New Address

Property Owner Property owner could be yourself. If you rent, please provide property owners name.

Home or Cell Phone

Work Phone

Have a previous address? Have a previous address? Yes No

Please provide your previous address

Please provide your previous Landlords name

Please provide your previous Landlords number

Years at previous address

Ever had City of Falmouth utilities? Ever had City of Falmouth utilities? Have you or anyone residing with you ever had City of Falmouth Utilities? Yes No

What year City of Falmouth Utilities?

Name of person who had City of Falmouth Utilities?

Number of total residents living at the new location Just MyselfMyself +1Myself +2Myself +3Myself +4Myself +5Myself +6Myself +7Myself +8Myself +9Myself +10Myself +11

Upload Photo ID Upload or take a picture of your Photo ID File InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, gif, png, webp, heic, heics, 3gp, 3gpp, 3g2, 3gp2. Max. file size: 256 MB

Emergency contact Information Emergency Contact Name

Emergency Contact Address Provide Emergency Contact address

Please Sign Authorization The undersigned acknowledges that service is provided subject to adherence to the City of Falmouth’s Ordinances. Undersigned agrees to receive and pay for electric and/or water/sewer/garbage service(s) in accordance with the rates, rules and guidelines set within the City Ordinances. By signing this application I give permission to my landlord to have access to my utility account. SaveClear

Type out Signature name

Electric deposit total Electric Deposit $250.00

Water deposit total Water Deposit $150.00

Paid With Paid With Cash Check Money Order