Lake Mills Light & Water

	Change Mailing Address
	Transfer Service
	Terminate Service
	New Residential Service
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	Report Street Light Outage
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Welcome to Lake Mills! We’re happy to be your new utility provider.

Please complete the form below to establish service at your new residence. We are available for connects and disconnects Monday through Friday. We do require a 24 hour notice.

*Date of new service
New Address
*Name(s) on account
*Street address
Apartment number
*City
*State
*Zip
*Rent or Own	Rent Own
*Daytime phone number
*Evening phone number
Mobile phone number
Email
Emergency Contact phone number
Landlord name
Landlord phone number

Previous Address
*Street address
*City
*State
*Zip
*Rent or Own	Rent Own
Landlord name
Landlord phone number

Employer
Employer name
Daytime phone number

Spouse or Roommate Information
Name
Employer name
Daytime phone number
Second Roomate
Name
Employer name
Daytime phone number

Any other specific instructions:
For our meter reader's safety, if you own a dog, what breed is your canine?
Dog's name
Are there any other animals in your home? Please list:
*To help reduce spam, please answer this math problem: 2 + 2 =

*Required fields: this information is required to open a new account for electric service. The utility may need to contact you to verify any or all of the information.