Set-up New Utility Service Account Online Form

This online form provides the City of Elko New Market the information needed to set-up a new utility service account. The City requires completion of this online form or the Utility Service Form (PDF format) before a new account can be created.

Service Address:
Please provide the service address below by entering the house number and locating the street name of the property in the pull-down list.

House Number *

Street Name *

Zip Code *

Occupancy Status *

Please enter the date of closing:

Date of Closing *

Please enter your date of move-in:

Move In Date *

Requester Contact Information:
Please provide your contact information below.

Full Name *

Phone Number *

Cell Phone Number

Email Address

Property Owner Information:
If this property is occupied by a renter, please provide property owner information below.

Full Name

Street Address

City, State, Zip

Mailing Address:
Please fill out this section only if you require your monthly utility bill to be mailed to a different address than the service address above.

Mailing Address

City, State, Zip

Additional Comments:
Please provide any additional information or comments below.

Additional Comments

I Accept * By checking this box, I state that I have authority to direct the City to add or modify information regarding the above service address.

* - denotes required field