TURN ON DATE
NAME
SERVICE ADDRESS
MAILING ADDRESS
PHONE NUMBER
SIGNATURE
DATE
FOR OFFICIAL USE
ACCOUNT NUMBER
ELECTRIC SERVICE CHARGE
WATER SERVICE CHARGE
TOTAL SERVICE CHARGE
BILL ACCOUNT YES NO
COMPUTER ENTRY BY
DATE
City of Fallon
Owner Service Request
Please fill out & sign the following form digitally, or print and fill out. Then, submit it with one of the following methods:
1. Scan and email to: clerksoffice@fallonnevada.gov
2. Fax to the City of Fallon: 775-423-8874
3. Print and bring into the City of Fallon Clerk's Office.
click to sign
signature
click to edit