City of Hood River Start/Stop Utility Service Application CompanyThis field is for validation purposes and should be left unchanged. Please Note: New Utility Accounts will have a one-time $20.00 processing fee (applied to first bill). We only process start/stop utility service applications in the current billing month. Customers are more than welcome to put in for future dates if needed. Applications must be received with a minimum of two business days prior to the request move date for processing time. Submitting the application late may cause the account to start/stop in the next billing month. Effective Date* Move In or Move Out* Move In Move Out Own or Rent* Owner Renter For Owner, if moving out Sold Property (Move out is per confirmed closing date of sale) Leased Property (Tenant will need to submit application of move in) Occupant Contact InformationOccupant Name 1* First Last Occupant Name 2 First Last Service Address* Street Address City State / Province / Region ZIP / Postal Code Mailing Address Sames as Service Address Mailing Address Same as Service Address Mailing Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Occupant Phone Number 1*Occupant Phone Number 2Occupant Email 1* Occupant Email 2 Property Owner/Management Contact Information Renters, you must provide the Property Owner/Management information below for the application to be processed.Property Owner Information same as Occupant Information Property Owner Name & Contact Information same as Occupant Property Owner/Management Name 1* First Last Property Owner/Management Name 2 First Last Property Owner/Management Mailing Address Sames as Service Address Property Owner/Management Mailing Address Same as Service Address Property Owner/Management Address* Street Address City State / Province / Region ZIP / Postal Code Property Owner/Management Phone 1*Property Owner/Management Phone 2Property Owner/Management Email 1 Property Owner/Management Email 2 I UNDERSTAND THAT IF I DO NOT PAY MY UTILITY BILL IN A TIMELY MANNER, THE PROPERTY OWNER/MANAGEMENT OF THE PROPERTY WILL BE NOTIFIED. I ALSO UNDERSTAND THAT UTILITY SERVICES MAY BE TERMINATED UNTIL PAYMENT IS RECEIVED IN FULL. AS CONSIDERATION FOR UTILITY SERVICES PROVIDED BY THE CITY OF HOOD RIVER, I AGREE TO COMPLY WITH ALL APPLICABLE ORDINANCES, RESOLUTIONS, AND POLICIES OF THE CITY OF HOOD RIVER. I have agreed to submit this form by electronic means. By signing this application electronically, I certify under penalty of perjury and false swearing that my answers are correct and complete to the best of my knowledge. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. Please type your name in below for your signature:Occupant Signature* First Last Occupant Acknowledgement* By checking this box and typing my name above it, I am electronically signing this document. Property Owner/Management Signature* First Last Property Owner/Management Acknowledgement* By checking this box and typing my name above it, I am electronically signing this document.