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2. Date to begin service*
   Date to begin service
3. Pre-authorized Payment (PAP)

   1. Yes! I wish to participate

   Fill out the PAP Form found at http://www.rfcity.org/DocumentCenter/View/1131 and include a voided check and drop off or mail to: RFMU, 222 Lewis Street, River Falls, WI
5. Service Property*

   1. Rent
   2. Own
7. Type of Business*
9. Tax Exempt?*

   1. Yes
   2. No
11. Business Name*
12. Phone Number*
14. Service address*
15. River Falls, WI 54022
17. Mailing address
    If different than service address. Include Street/PO Box, City, State, Zip
19. CONTACTS:
21. Business Owner*
22. Phone*
23. Email
25. On-site Manager*
26. Phone*
27. Email
29. Accounts Payable*
30. Phone*
31. Email
33. Emergency contact*
34. Phone*
    Emergency Contact's Phone Number
36. 
37. Renewable Energy Block Program

    1. YES, I agree to purchase 1 Block of Renewable Energy at $2.00 per month. Clean, affordable, "never running out" power from natural resources like wind, solar and biogas.

    This purchase will appear as an additional charge on my monthly utility bill. Additional blocks are available for $2/block. I understand that we can change our participation level or cancel at any time.

39. I agree to abide by the rules and regulations set forth by this utility and to pay for services at the specified rate. Utility rules require that assigned rate schedules remain in effect for a minimum of twelve (12) months. I understand that a non-payment of utility bills could result in interrupted service and require posting of a deposit. It is understood that current copies of the utility rules, regulations and rates are on file at the utility office and available to me for my information. Upon termination of this service, I understand that it is my responsibility to notify the Utility to request my utility service be terminated or changed from my name.
41. Customer Signature*
42. Date*
44. Approved by
    Utility signature
45. Date
47. For Utility Office Use Only:
49. Utility Charge(s): Electric __________ Water__________ Sewer__________
51. City Charges: Env Fee __________ Storm Water ________ Public Fire Protection__________
53. Entered by:__________ Account#_______________ Cy/Rt/Wk____________ Customer#______________
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field