New Haven Form Center

2. Who Can Fill Out This Form?

   • Homeowners
   • Landlords
   • Tenants

   Fill out and submit to begin receiving service and bills for City-provided utilities. Please note that a $100.00 deposit will be added to the first month's bill for residential customers,  Commercial Deposits will vary. For questions please contact the utility office. 

   You can receive a duplicate bill at the owner's request by emailing Utility Billing at UtilityOffice@NewHaven.IN.gov.

4. New Haven Utilities Service Agreement

6. Effective Date/Date of Closing*
   Effective Date/Date of Closing
7. Is the New Resident at This Address...*

   1. New to New Haven
   2. Current of Previous New Haven Resident
   3. Don't Know

9. Billing Information

11. Customer Name*
13. Service Address*
15. Billing Address

    If different from service address

17. DOB*
18. Phone Number*
19. Driver's License #*
21. Electronic Signature Agreement*

    Customer agrees to abide and be bound by the Utility's Rules and Regulations governing water- service to its customers which Rules and Regulations are incorporated in the contract. The Utility's Rules and Regulations may be amended from time to time, and all amendments  shall become a part of this contract at the time of their adoption.

    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.

    1. I agree.
23. Electronic Signature
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