Form Center

2. Name*
4. Phone Number*
5. Alternate Phone Number
7. Email Address
9. Service Address*
11. Mailing Address*
13. Do you own the property?*

    1. Yes, I own the property.
    2. No, I agree to complete the Utility Application Form and understand my online submission will not be accepted.

    Online submissions from renters will not be accepted. If you are renting the property, please complete the Utility Application Form with all required signatures.

14. Date Occupancy Begins*
    Date Occupancy Begins
16. Do you wish to receive your bill via email?

    1. I agree and understand.

    I elect to receive my bill electronically. I will keep my email address updated with the City of Grand Ledge Utility Billing system. I understand that failure to receive a bill does not exempt me from penalty/collection activity or shut off subject to applicable notice requirements. I understand that I will no longer receive a postcard copy of my bill.

18. Unpaid bills are a lien on the property. Failure to receive bill does not waive penalty.*

    I agree I am responsible for any damages to the property of the City of Grand Ledge caused by my negligence. I agree to promptly pay any water/sewer bills, along with any fees I may incur. I understand failure to make timely payment may result in the City of Grand Ledge using all means permitted by law to collect the debt.

    1. I understand.
20. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
22. Applicant Electronic Signature*
23. Date*
    Date
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field