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Application For Utility Services

  1. Village Letter Head Online Forms

  2. Application For Utility Services

  3. Do you also reside at this address?*

  4. Check all that apply*

  5. I understand that according to village ordinance, I am responsible for prompt payment of any charges incurred on my account. I further understand that if payment is not received on my account or if any other policy is violated, my services may be terminated upon notice by the Village of Channahon and I would be responsible for any and all payments for reconnection fees, collection fees, and court costs incurred by the Village of Channahon as a result of this matter.

  6. I have read and agree to the following statements above.*

  7. The following information is required of applicants to establish service:

  8. Please select one of the following:*

  9. *PLEASE FILL OUT THE FOLLOWING INFORMATION IF DIFFERENT FROM APPLICANT*

    Contact Information for Property Owner of Service Address

  10. Residential and commercial accounts, including all multi-family dwellings on Village water supply, are billed on a monthly basis. Refuse only accounts are billed on a quarterly basis. Bills are due and payable within thirty (30) days of billing date. Unpaid accounts will incur a late charge of 10% per month based on the unpaid balance. Water, sewer, and refuse rates are subject to change by Village Board action. Current rates are as follows:

  11. WATER (WA) RATES:

    $6.22/1,000 gallons usage fee

  12. SEWER (SW) RATES:

    $7.67/1,000 gallons usage fee $5.00 per Account Charge

  13. Refuse-Choose One:

  14. PLEASE CHECK WHICH STATEMENT(S) APPLY:

  15. I have read and understand the provisions of this application and agree to abide by the provisions of such service as provided in the Village of Channahon Code of Ordinances.

  16. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  17. IMPORTANT: THIS FORM MUST BE RETURNED TO OUR OFFICE WITHIN 10 DAYS TO AVOID INTERRUPTION IN SERVICES.

  18. rev 07.18.2019

  19. Leave This Blank:

  20. This field is not part of the form submission.