HomeMy WebLinkAboutOwner Application5.9.2025Owner Application for Service
South Bend Municipal Utilities
125 W. Colfax Ave, South Bend IN 46601
Phone: 574-233-0311 Email: 311@southbendin.gov
Date: ________ Service Address: ____________________________________
Name of Property Owner:
__________________________________________________________
Primary Phone Number:
__________________________________________________________
If property is in the name of a business, name of legal agent of the business:
__________________________________________________________
Social Security Number: ____-____-____ Federal Tax ID (if a business):____________
Type of ID (circle one): Driver’s License State ID Passport
Identification Number: ____________________________________________
Date of birth: (MM/DD/YYYY): ________________________________________
Date to start service: _____________ (circle one: AM PM )
Mailing address (if different from service address):
__________________________________________________________
Email address: _________________________________________________
Are you new to the City of South Bend? Yes No
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Do you currently have other water accounts with the City of South Bend?
Yes No
If you have another water account, what is the address for the account?
Service Address: ____________________________________________
____________________________________________
Are you planning to leave this service on, or do we need to schedule termination?
Yes, leave on No, schedule termination Date for termination: _____________
Signature of Property Owner: _________________________ Date: ____________
Office use only: Account #: ___________________________ Inside: ______ Outside: _______ Clay:______ Cycle/Route: ________
Type of Service: _____ Sewer _____ Water _____ Irrigation _____ Storm Water
Deposit: $__________ Meter Size: ________ Water: ______ Irrigation Service Initiation Fee: $______ Name of liaison: ___________