:: Johnson Utilities ::

Residential New Service

Name *

First

Last

Home Phone Number *

###

####

Cell Phone Number *

###

####

Email Address *

Social Security Number *

This information is required to start service.

Have you ever had service with Johnson Utilities *

Yes

If YES please provide your previous account address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Im requesting *

Water & Sewer (130.00 deposit) If Johnson Utilities provides both water and sewer to a service address a 130.00 deposit maybe required

Water Only (60.00 deposit maybe required)

Sewer Only (85.00 deposit maybe required)

Deposit Information
Johnson Utility customers are required to place a deposit as security for payment of utility bills before utility services will be turned on. Deposits may be waived if the applicant has had service with Johnson Utilities in the past two (2) years, was not delinquent in payment more than twice during the past twelve (12) consecutive months or been disconnected for nonpayment during the past twelve (12) months. Deposits do accrue interest.

Credit Card # to be used for Security Deposit *

We only accept Visa, Master Card, Discover.
Debit Cards are gladly accepted as long as they have the Visa MasterCard emblem. Please Note: Your credit card will be charged a security deposit. If the credit card provided is declined for any reason your security deposit will be applied to your first months bill.

Credit Card Expiration Date *

YYYY

Credit Card Security Code *

This is the last 3 digits on the back of your Credit Card

Please have service connected on this date *

YYYY

Please allow 24 Hours in advance Monday-Friday
If today is Friday service will be connected the next business day which would be Monday

Please enter the address you wish to start service. *

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Are you the: *

Owner

Tenant (Lease maybe required prior to starting services)

Mailing/Billing Address *

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

I understand that there will be an establishment fee on my first months bill according to the service I require. *

yes

Establishment Fee for Water: $25.00
Establishment Fee for Sewer: $25.00

Please type in your First and Last name. *

First

Last

By entering your First and Last name you are requesting Johnson Utilities to establish service to the address you provided starting on the date you requested. You also give Johnson Utilities permission to contact you at the phone numbers provided. Johnson Utilities’ Customer Service Representative will be contacting you shortly to gather your security deposit payment please have your Visa, MasterCard, or Discover available. You request Johnson Utilities to turn on services at the address provided. Johnson Utilities will not be held responsible for any water damage that may occur. We strongly suggest someone be present at the home on the date requested services to be turned on. If you do not agree to this, we will not be able to process your request online and you will need to visit our office location or contact the Customer Service Call Center at 480-987-9870.

Image Verification
	Please enter the text from the image: [Refresh Image] [What's This?]