City of Denham Springs

The City of Denham Springs

Utility Services Application

Requested Service(s)

Water

Sewer

Garbage/Recycling

Gas

Is this property owned by the applicant?

Applicant Information

Applicant

Billing Full Name

Phone Number

Social Security Number

Date of Birth

Spouse

Full Name

Phone Number

Social Security Number

Date of Birth

Mailing Address

Street Address

Apt/Suite/Unit (optional)

City

State

Postal/Zip Code

Most Recent Address

Same as Mailing Address

Street Address

Apt/Suite/Unit (optional)

City

State

Postal/Zip Code

Utility Service Address

Street Address

Apt/Suite/Unit (optional)

City

State

Postal/Zip Code

Occupant Information

Occupant 1

Occupant Name

Phone Number

Occupant 2

Occupant Name

Phone Number

Previous or Current Service under Other Names or Locations in the Last Five (5) Years

Service Start Date

Comment

Driver’s License or Government Issued Picture ID

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Certification NOTE: A two-hour appointment time is necessary to connect GAS services. A person of legal age must be at this location during the time requested. If you are not at this address when we arrive, it will be necessary for you to call our office and reschedule your ‘light-up’ time for a future date. A service charge of $25.00 may be charged for missed appointments

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