2. 
4. Service Address
   Physical Address of the Business
5. E-Mail Address*
7. City
8. State
9. Zip Code
11. Business Name
    Business Name/Company Name
13. Business Contact Name
14. Email Address
16. Billing Street Address
18. City
19. State
20. Zip Code
22. Phone Number
23. Fax Number
25. Date to Start Service
27. Digital Signature
    By digitally signing this form, I certify I am the above named account holder and authorize the City of Cheney to start a utility account in my name or the name of the company. Please see the FAQ section on the Utility Billing Service page for deposit, billing and due date information. Applicant agrees the City may use applicant's identifying information for the purpose of administering, enforcing, collecting or completing financial transactions for City Utilities.
29. Frequently Asked Utility Billing Questions
    Utility Billing FAQ
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field