Town of Pierceton – Utilities Customer Contract

Please fill out the form below as thoroughly as possible. If you have any questions or concerns, please feel free to contact the Clerk’s office.

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Full Legal Name
Information is kept confidential
I am the property:
The Town of Pierceton collects a $67.00 meter deposit
In the event of an emergency concerning your water and/or wastewater service, please provide us with the following emergency contact information, name and phone.
I hereby contract with the Town of Pierceton Indiana utilities for service and agree to pay for such service in accordance with it’s established rates. I also agree to conform to all Town of Pierceton utilities rules, regulations, and standards of service and applicable Indiana law, governing the use of water, wastewater now in force or which may hereafter be adopted.
Click or drag files to this area to upload. You can upload up to 2 files.
Photo ID (Driver’s license or State ID) – Item’s are kept confidential