2. City of Eudora Application for Disconnection of Utility Services

   Complete the online form below to submit your application for disconnection. If you would like to contact us by phone, you may call (785) 542-2153.

   Please Note: Please allow one business day for services to be disconnected once the application has been approved.

   The undersigned hereby makes application for utilities at said premises. The undersigned hereby agrees to comply with all City Ordinances concerning utilities and to pay for services rendered at the City’s prescribed and approved rates.

   Account holder and/or recipient of services shall pay any and all charges related to the reasonable costs of collection of this account/service. The cost of collection include, but are not limited to, court costs, surcharges, attorney fees, and collection agency fee, except that such costs of collection may not include both attorney fees and collection agency fees. This is per Ordinance 1071 that was passed on November 13, 2017 and published November 16, 2017.

   By submitting this application, applicant(s) are signing this application electronically. Applicant(s) agree their electronic signature is the legal equivalent of their manual signature on this application. By submitting this application all applicants consent to be bound by the terms listed above.

4. Today's Date
   Today's Date
5. Service End Date*
   Service End Date
7. Service Address:*
9. Name:*
11. Are you moving to another address in Eudora?*

    1. Yes
    2. No
13. Forwarding Billing Address*

    Your final bill will be sent to this address.

15. New Eudora Services Address*

    Your current bill/balance will be transferred to this new account.

16. New Service Address Start Date*
    New Service Address Start Date
18. Phone Number:*
20. Email:
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field