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4. Any person (Over 18) listed on a lease or purchase agreement must supply the information below.
6. Person 1
8. First Name*
9. Last Name*
11. Phone Number*
12. Email Address
14. Is There an Additional Person on The Lease?*

    1. Yes
    2. No
16. Person 2 First Name
17. Person 2 Last Name
19. Person 2 Phone Number
20. Person 2 Email Address
22. Is There a Third Person on The Lease?

    1. Yes
    2. No
24. Person 3 First Name
25. Person 3 Last Name
27. Person 3 Phone Number
28. Person 3 Email Address
30. Is There a Fourth Person on The Lease?

    1. Yes
    2. No
32. Person 4 First Name
33. Person 4 Last Name
35. Person 4 Phone Number
36. Person 4 Email Address
40. Service Address
42. Address Line 1*
44. Address Line 2
46. City
47. State
49. Zip Code
51. Is your mailing address different from you service address?*

    1. Yes

    1. No
53. Mailing Address Line 1
55. Mailing Address Line 2
57. Mailing City
58. Mailing State
60. Mailing Zip Code
62. Phone Number
63. Email Address
65. Have you previously had service with the Coldwater Board of Public Utilities?*

    1. Yes
    2. No

    If you are not a previous account holder, the CBPU determines deposits using ONLINE INFORMATION SERVICES. Therefore, you may or may not have to pay a deposit before establishing your account. Deposits can range from $0 to $400 based on the response from ONLINE INFORMATION SERVICES.

69. What date do you wish to start services at the above address?
    What date do you wish to start services at the above address?
71. Which services do you wish to start at the service address?

    1. Electric
    2. Water/Sewer

    1. Garbage
    2. GIG Fiber / Cable Modem Internet

    1. Skitter TV / Acclaim
    2. Phone
73. Do You Want More Than One Garbage Totes?

    1. Yes
    2. No
74. Do You Want a Recycling Tote(s)?

    1. Yes
    2. No
76. Number of Garbage Totes Requested
78. Acknowledgement

    We will contact you at the phone number you have provided to complete the process of your service request. 

82. *See RRR for fees/deposits associated with establishing new service.
    Click Here
84. Activation and installation fees may apply for new services.
86. Telecom equipment must be returned upon cancellation of services. Your account will be billed for equipment that is not returned.
88. If this form does not cover your request, please feel free to contact CBPU at 517-279-9531, Monday-Friday, 8:30 a.m. to 5:00 p.m.
Leave This Blank:


90. 1. Receive an email copy of this form.
91. Email address

    This field is not part of the form submission.

92. Submit

* indicates a required field