2. Request for Temporary Services with the City of Pierre
4. Date*
   Date

   enter today's date

5. Date Services Begin*
   Date Services Begin

   enter the date you want services to begin

6. Date Services End*
   Date Services End

   enter the date you want services to end

8. Reason for Temporary Service?

   Examples: Landlord to clean, contractor to remodel, etc. Please provide a clear explanation for purpose of temporary services. 

10. NOTICE!

    For Temporary Services, the start and end date is required. If you are unsure of the dates, use your best guess. Changes to these dates can be made by submitting a modification through the Modify Temporary Services Form. 

    Please note services will terminate on the date listed on this Request Form unless a modification is submitted. It is the Customer's Responsibility to manage these dates. 

12. Name*

    Customer responsible for the billed services per this request.

13. Customer is*

    1. Landlord
    2. Property Owner
14. Phone Number*
16. Email Address*
18. Service Address*

    Enter the address for temporary services

20. Mailing Address*

    enter the address to send your utility bill

22. The City of Pierre will review your request and determine if a Utility Deposit is required for the temporary services requested. 

    The above listed customer requests temporary utility services from the City of Pierre . Customer is responsible for all bills and charges at this address until the requested date as listed above.

Leave This Blank:


24. Submit Submit and Print

* indicates a required field