Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Town of Benson - Utilities Application

  1. Choose one:

  2. Choose one: *

  3. 1. Account Holder or Authorized Employee (please fill up)

  4. 2. Traditional Customers Only (deposits, fees, and past due payments are required to start services)

  5. Service Details:

  6. TRANSFERS ONLY (fee and current bill must be paid):

  7. Apply $ to New Account:

  8. 3. Prepaid Customers Only

  9. Notification Information:

  10. Send the Following Notifications:

  11. Notification 1

  12. Notification 2 (if available):

  13. MyUsage Setup:

  14. 4. Please Check for USDA Reporting Purpose Only

  15. Gender:

  16. Race

  17. 5. Customer Agreement (this section must be initialed and signed by applicant)

  18. BY SIGNING THIS APPLICATION I AUTHORIZE THE TOWN OF BENSON TO USE MY INFORMATION TO DETERMINE MY DEPOSIT AND UTILITY ACCOUNT ELIGIBILITY.

  19. FOR TRADITIONAL CUSTOMERS SWITCHING TO PREPAY ONLY, I UNDERSTAND IF I WANT TO SWITCH BACK TO TRADITIONAL BILLING, A NEW DEPOSIT WILL BE REQUIRED.

  20. BY TYPING YOUR FULL NAME INTO THIS FIELD YOU ARE SIGNING THIS DOCUMENT.

  21. Leave This Blank:

  22. This field is not part of the form submission.