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Application For Utility Services

  1. (If married, enter name of husband and wife, both must sign. If business, enter the name of the company.)

  2. Any Previous Service with City of Moss Point or EUD

  3. Service Desired (select one)

  4. 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.

  5. Applicants will have to provide their driver’s license, proof of inspection, social security card, and proof of residency at the Utilities Office to complete the application process.

  6. Leave This Blank:

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