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2. Application for Water Service
4. Owner or Renter's Name
6. This Property Will Be:

   1. Owner Occupied

   1. Rented
8. Address of Service Requested

   *Address must be withing the Village of Schiller Park, IL*

10. Status of the Property at the Time of the Service

    1. Owner Occupied

    1. Rented

    1. Alternate Billing Address
12. Billing Name
14. Billing Address

    Street, City, State, Zipcode

16. I understand that signing this agreement requires me to abide by and accept all applicable Village ordinances and regulations (primarily contained in Chapter 53 of the Village’s Municipal Code) relating to receiving water service, the payment for such service, and the use of the potable water provided.
    
    I further understand that I am responsible, as the owner of the above referenced premises, for all outstanding and/or past due fees and costs relating to the provision of water service to the above referenced premises, including but not limited to the costs of water service, sewer service, and meter installation or repair, regardless of whether these fees are for services provided when I was the owner of the above referenced premises.
    
    I further understand that I must pay these fees in full before water service at the above referenced premises can be commenced or resumed under my name.
18. Signature of Property Owner
19. Today's Date
    Today's Date
21. Phone Number*
23. Email Address*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field