Town of Pierceton – Utilities Customer Contract | Welcome to the Town of Pierceton Indiana

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

First

Middle

Last

Service Address

Mailing Address

Drivers License #

Information is kept confidential

Telephone Number

I am the property:

Owner
Tenant
Other *(explain below)

* Other explanation

Name of property owner

Property owners phone

Requested date of change

Customer Account #

The Town of Pierceton collects a $67.00 meter deposit

Emergency water/wastewater contact name

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.

Emergency water/wastewater contact phone

Type your name as your signiture

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.

Date of signiture

Please include a clear picture of the front and back of picture ID

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