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Commercial Service Application

This form must be used by any individual or organization requesting to start commercial services in the city of Mishawaka. After submitting this form a commercial account representative will review the application and reach out to you within 2-3 business days if additional information is required. If your applications is successfully reviewed and verified you will receive an automated email with additional instructions and next steps for completing the setup of your services. If at anytime you have any questions please contact us via phone at (574) 258-1630 or email at mubilling@mishawaka.in.gov

Billing Information

Corporate Name:*

DBA/Trade Name:*

Service Street Address:*

Mailing Address:*

Address Line 2:

City:*

State*

Zipcode:*

How would you like to receive the bill?*

Email*

Service Start Date: (no weekends or holidays!)*

**Please note we do NOT offer same day service. If your request is received after 3 P.M. EST it will not be processed until the following business day.**

Principals,Officers and/or Owners

Contact 1

First Name*

Last Name*

Owner/Title:*

Home Address*

Address Line 2

City*

State*

Zip Code*

Social Security Number:*

Phone Number*

Phone Type:*

Email Address*

Contact 2

First Name*

Last Name*

Owner/Title:*

Home Address*

Address Line 2

City*

State*

Zip Code*

Social Security Number:*

Phone Number*

Phone Type:*

Email Address*

Contact 3

First Name*

Last Name*

Owner/Title:*

Home Address*

Address Line 2

City*

State*

Zip Code*

Social Security Number:*

Phone Number*

Phone Type:*

Email Address*

Property Owner Information

First Name*

Last Name*

Street Address*

Address Line 2

City*

State*

Zip Code*

Phone Number*

Email Address*

Property Ownership Type:*

Document Upload

1. Articles of Incorporation

Take Picture/Video

2. W9

Take Picture/Video

3. A copy of your lease or purchase agreement

Take Picture/Video

4. Photo ID's of all Principal, Officer or Owners

Take Picture/Video

Form Preparer

First Name:*

Last Name:*

Titile:*

Please provide the email address of the person who will be the main point of contact throughout the application process

Email*

Date:*

Signature:

Sign Document

Clear

Done

Commercial Service Application

Billing Information

Company Information

Principals,Officers and/or Owners

Property Owner Information

Document Upload

Form Preparer