City of Modesto Secure Web Client

City of Modesto - New Utility Service Request Form

Please fill out this form to request NEW UTILITY SERVICE from the City of Modesto.

Fields with an "*" are required entries.

Customer Contact Information:

1) Name*

2) Service Address*

3) Mailing Address*

4) Phone Number*

5) Email Address*

6) Confirm Email Address*

Customer Identification:

7) Social Security Number

8a) ID Type*

8b) ID Number*

9) Are you the Owner or Tenant at the service location?*

Additional Party Information:

Please note: Each party listed on the title or lease agreement over the age of 18 will be considered a responsible party
and must provide either a Social Security Number, Valid California Drivers License ID or Valid California Identification card.

Additional Party Information if needed. Additional Party is other person who will also be responsible for the bill.

10a) Name

10b) Social Security Number

10c) ID Type

10d) ID Number

Service Information:

Have you or any additional party listed above had prior service with the City of Modesto?

11a) Prior Service?*

11b) Prior Service Address

12) Is water service currently on?*

13a) How many black cans are at the property?*

13b) How many green cans are at the property?*

13c) How many blue cans are at the property?*

What Files to Attach:

Copy of your state issued ID
For Tenants - Please provide a copy of your Lease/Rental Agreement
For Owners - Please provide Proof of Ownership (i.e. Grant Deed or Final Escrow Settlement Statement)

14) State Issued ID*

Drop files here, or browse to attach files

Confirmation Required

Are you sure you want to remove the selected file?

15) Rental/Lease Agreement or Final Statement*

Drop files here, or browse to attach files

Confirmation Required

Are you sure you want to remove the selected file?

16) Other Document (Ex: Letter of Credit)

Drop files here, or browse to attach files

Confirmation Required

Are you sure you want to remove the selected file?

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