By submitting this form I am indicating my request for the City of Atchison to provide water utility service to me at the following location. I agree to pay for all water, wastewater and refuse service rendered and used at this address until I have notified the City of Atchison of the date to terminate service. I understand the charges for the service provided will be according to the rate schedule approved for this class of service. I understand that the City of Atchison has the right to disconnect my service if I do not pay, when due, any obligation owed by me to the City of Atchison. I give my consent to the City of Atchison to transfer any unpaid balances from previous utility accounts that I have had with the City of Atchison to this account. I understand that upon receipt of this information form, a $5.00 plus applicable tax turn on fee will appear on my first statement. There is no deposit required. When indicating the date wanted below, select a date other than today, weekends, or holidays. Requests for service at an address that involves new construction or mobile home need to be made by phone (913-367-5500) rather than through this form.