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Application For Utility Services

  1. City of Miss Point and Escatawapa Suburban and Utility District
  2. The undersigned applicant(s) makes application for utility services at and upon the premises below and agree to the terms and conditions of the Utility Service Rules and Regulations. A copy of which are hereby acknowledged and received by the undersigned. The applicant(s) do further agree to follow and abide all resolutions, order and ordinances of the City and EUD pertaining and connected in any way to utilities and utility service. The applicant(s) agrees that the following information furnished true and correct:
  3. (If married, enter name of husband and wife, both must sign. If business, enter the name of the company.)
  4. Any Previous Service with City of Moss Point or EUD
  5. Service Desired (select one)
  6. In Case of Emergency Call:
  7. 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.
  8. Completing Utility Form
    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.
  9. Leave This Blank:

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