Valparaiso City Utilities

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Online Service Agreement - Residential
Location of Service
Requested Service Start Date (mm-dd-yyyy)
Applicant 1 Details
Full Name
Driver License
Date of Birth (mm-dd-yyyy)
Home Phone
Cell Phone
Last 4 Digits SSN (Applicant 1)
Email Address
I hereby request service from the Valparaiso City Utilities, Valparaiso, Indiana. I understand that services include water, sewer, storm water and trash service as applicable:
Bills for Cycle 2 are sent out before the 5th of each month for water, sewer, storm water and/or trash and that payment is due by the 20th of the same month after which a penalty is added to the amount due. Service shall be terminated if my bill is not paid by the 10th of the following month and an administration fee will be added to the amount due.
Bills for Cycle 1 are sent out before the 15th of each month for water, sewer, storm water and/or trash and that payment is due by the 1st of the following month after which a penalty is added to the amount due. Service shall be terminated if my bill is not paid by the 20th of that month and an administration fee will be added to the amount due.
I understand that I will be responsible for all collection fees, attorney fees, court costs and other related charges necessary to enforce the terms of this Agreement.
I understand that I must have a responsible person available at the location of service mentioned above so that the service can be turned on and that the same shall apply when I have notified VCU that I desire service to be terminated.
I understand and acknowledge the VCU cannot guarantee nor be responsible for the maintenance of water pressure or volume due to circumstances beyond its control.
I am
I understand all parts of the Agreement and will comply with its terms.
Signature of Applicant 1
Applicant 2 Details
Full Name
Driver License
Date of Birth (mm-dd-yyyy)
Last 4 Digits SSN (Applicant 2)
Cell Phone
Signature of Applicant 2
Mailing address if different than service address (P O Box, etc.)
Emergency contact persons name and phone number
Type of Payment
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