PRINTABLE CUSTOMER FORMS

You can download / print the following forms.  Please fill out in full and mail to:

Valparaiso City Utilities
Attention: Customer Service
205 Billings Street
Valparaiso, IN 46383 

City Utility Forms

• ACH / Direct Debit Cancellation (PDF) - Use this form if you wish to cancel your ACH / direct debit account or if you are changing banks and wish to continue using ACH / direct debit with your new account.
• ACH / Direct Debit Water Bill Payment (PDF) - Use this form to set up automatic payments to have your water bill deducted from your checking account automatically.
• Social Security Late Fee Waiver (PDF) - Use this form if you are on Social Security and your payment comes after your water bill, resulting in a late penalty. We will waive the late penalty on all your bills after this form is submitted.
• Valparaiso City Utilities Residential Service Agreement Card (PDF) - Use this form if you are new to the area and cannot make it into the office to set up your account. This agreement card is required for all new water accounts.

Note: These files are best viewed with the latest version of Adobe Acrobat Reader. Access Adobe's website for more information and free download.