2. Services Requested*

   Please check all that apply.
   NOTE: Not all services are available at all address locations.

   1. Water
   2. Sewer
   3. Trash
   4. Yard Waste Cart (One cart included free with trash service)
4. Turn on Date Desired*
   Turn on Date Desired

   NO WEEKEND OR HOLIDAY SERVICES

6. Own/Rent*

   1. I own my home
   2. I rent
8. Service Address*
10. City
11. State
12. Zip Code
14. Subdivision
15. Lot Number

    (if applicable)

16. Builder

    (if applicable)

18. Name for Billing*
20. Billing Address

    (if different)

22. Billing City
23. Billing State
24. Billing Zip Code
26. Daytime Phone Number*
27. Evening/Alternate Phone Number
29. Email Address
31. Date of Birth*
    Date of Birth
32. Driver License / Government ID*
36. Previous Address
38. Previous Address City
39. Previous Address State
40. Previous Address Zip
44. Property Owner Name

    (rental only)

46. Owner Address

    (rental only)

48. Owner Address City
49. Owner Address State
50. Owner Address Zip
52. Owner Phone Number
56. Trash Can Delivery Option

    All trash accounts have a $30.00 activation charge.
    For trash customers only, please select one of the following can delivery options:

    1. City to Deliver Containers: The city should deliver trash/yard waste container(s) to me.
    2. Moving Within St. Peters: I am moving from one location in St. Peters to another. I will bring my container(s) with me when I move.
58. The address I'm bringing the containers from is

    (if in St. Peters)

Leave This Blank:


61. Submit

* indicates a required field