Start Service and Payment Plan "*" indicates required fields Use this form to request a service application for new service and service changes, or payment plan application. Please complete all areas of this form. Incomplete forms will delay the process time. Directions: Use the tab key or your mouse to move through the fields. All information given to Nebraska City Utilities will be confidential and used only to mail appropriate request.Name* Date for Service Start Up* HOME OWNER ? YES NO RENTER ? YES NO Service Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number* Email* Select Application Request Service Application Level Payment Plan Automatic Bank Payment (EFT) Upload Photo IDMax. file size: 50 MB.Photo ID is required when selecting Service Application. This is required for security and safety of our customers to verify that service is being set up under correct identification. Services will not be implemented without appropriate identification. Please scan or take a photo of your ID and upload the image here.Additional Information
