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New Utility Service Form


  1. 1. Residential Utility Application
  2. 2. City of Melissa Service Agreement
  3. 3. Notice of Right to Request Confidentiality
  4. 4. Sign & Submit
  • Residential Utility Application

    1. Numbers only, no dashes.
    2. Requested service date must be no more than two weeks from the date of service form submittal. Same-day service requests can only be honored if the form is submitted prior to 2:00 p.m.
    3. Property Type:*
    4. I understand that by submitting this application, I am representing to the City of Melissa that I am the owner or lessee/tenant of the property and that I am authorized to request utility service at the property identified above. I agree to defend and indemnify the City of Melissa and its officials, employees, contractors and agents from and against any and all claims, causes of action, demands, complaints and/or assertions alleging that any information, statements or representations provided in connection with this application are false or incomplete in any way.

    5. I have had utility service through the City of Melissa before:*