City of La Cygne, Kansas

La Cygne, Kansas : City of the Swan on the Marais des Cygnes

On-Line Application for La Cygne Gas & Water Service

City of La Cygne On-Line Utiity Application
I understand that security deposits of $75 for water and $200 for gas service are required with all utility applications. Deposits must be in City Hall before services can be turned on. (Enter YES or NO)
Applicant's First Name:
Applicant's Middle Initial:
Applicant's Last Name:
Social Security No. of Applicant
Type of Service: Gas? Water? Both?
Start Service On: (Month/Day/Year)
Location of Service: (House # and Street Name/No.)
Property Owner other than Applicant
Place of Employment
Mailing Address: P. O. Box
Mailing Address: Number and Street
Mailing Address: City,State, Zip
Home Phone:	() -
Cell Phone:	() -
Work Phone:	() -
E-mail Address
I understand that the statement of account will be mailed to me the 1st day of each month. 10% late charges will be applied to unpaid bills on the 15th of each month. Accounts not paid by the last day of the month will be subject to shut off without further notice. (Enter YES or NO)
I understand that the City of La Cygne is NOT BOUND by any COLD WEATHER RULE in regards to utility shut offs during cold weather. (Enter YES or NO)
Please bring your drivers license when coming to City Hall. We will need a copy for our files. Thank You.
OFFICE USE ONLY - Deposit Paid:
OFFICE USE ONLY - Date Service Started:
OFFICE USE ONLY - Date Service Ended: