NEW RESIDENTIAL APPLICATION

New Residential Application

* Indicates required field

Applicant Name *

First

Last

Date of Birth *

Phone Number *

Cell Number *

Work Number *

Driver's Licenses *

State *

Social Security Number *

Email *

Co-Applicant information ***By adding a co-applicant, you authorize this person to have compete access to any/all account information including the right to cancel service and provide a forwarding address to the property listed.***

Co-Applicant Name *

First

Last

Date of Birth *

Phone Number *

Cell Number *

Work Number *

Driver's Licenses *

Select One *

Social Security Number *

Email *

What is the date you would like to start your service?
(Service can only be started on Working business days and cannot be any sooner then the next business day.)

Start Date *

Service Address *

City *

Zip Code *

Mailing Address (if different from above) *

Line 1

Line 2

City

State

Zip Code

Country

Will you Own or Rent your home? *

Own Rent Rent to Own

If Rent or Rent to Own what is the name of Landlord *

Landlord's Phone Number *

How many people will be living at this address?

Adults *

Children *

How would you like to receive your bill?

I would perfer *

Printed Copy (You will receive your bill in the Mail) E Billed (Please double check your email address above) Both Printed and E Billed

From time to time we will need get in touch with you to let you know that your water is being shut off either due to non payment or due to Public Works working in your area.

I would prefer *

A Robo Call (this is an automated call) A Text Message

Trash

Trash is an optional service provided by the City of Willard. Any person who has a water account may choose to also have trash added to their account. There is a $25 deposit and $14 a month will be added to the water/sewer bill. The City of Willard only does the billing for the following trash companies. If you have a issue (such as pickup date or needing a new can) you will have to contact the individual company directly.

Which Provider would you like? *

Patriot Trash Republic Trash WCA Trash

Recycling

Choose Any *

I live inside city limits and would like Free Recycling with my Trash

The City of Willard provides citizens who live inside the city limits free Recycling if they choose

(reminder you may opt in at any time for $25 deposit )

By clicking Submit, you agree to abide by all rules and polices established by the City of Willard, MO. (Available for review at City Hall). You also agree that you will NOT turn on or turn off your water meter or allow anybody else (including but not limited to professionals) for any reason.

Submit

We will NEED a digital COLOR copy of the Identification (Driver's License or other legal ID) for ALL person(s) who want to be on the account before we can complete the application.

Email the above Identification (most people are taking a picture of their ID) to the following emails (Please send to Both)