Signup for New Service

Fri, 04/04/2008 - 3:43pm — fpuboss

Signup for new service with Fayetteville Public Utilities online.

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Personal Information

Last Name: *

Last Name

First Name: *

Address Line 1 (911 Address): *

Address Line 2:

City: *

State: *

Zip: *

Driver's License Number: *

Driver's License State: *

Social Security Number: *

Daytime Telephone: *

Evening Telephone: *

Cell Phone:

Email Address:

Billing Information (Optional)

Billing Address Line 1:

Billing Address Line 2:

Billing City:

Billing State:

Billing Zip Code:

Spouse Info (Optional)

Spouse's Last Name:

Spouse's First Name:

Spouse's Social Security Number:

Renter Info (Optional)

Landlord Name:

Landlord's Telephone Number:

Select Services

Any Additional Comments:

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