Need to request a new utility connection, change your service, or inquire about other utility-related matters? We've got you covered! Download the form from by clicking the button below, or fill out the form using the online form below. Once completed, bring the filled-out forms to Town Hall, email them to ktoby@townofripleyok.gov, or use the upload button below to submit your completed application online. You will also need a copy of your ID submitted with the application, so please include that whether you come in person or email the form. Our friendly and knowledgeable staff will happily assist you promptly and efficiently. Whether you're a new resident or seeking to modify your existing services, we're here to help.

Contract for Utility Services Form

Name:

First Name

Last Name

Address Requiring Installation:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date to Install Services:

MM

DD

YYYY

Social Security Number:

Date of Birth:

MM

DD

YYYY

Home / Cell Number:

(###)

###

####

New Resident in Ripley?

Yes

No

Employer:

Employer Phone:

(###)

###

####

Spouse's Name:

First Name

Last Name

Name of Relative not Living at This Address:

First Name

Last Name

Relationship:

Phone Number:

(###)

###

####

Agreement

-THE DEPOSIT IS MADE AS SECURITY FOR PAYMENT OF SUMS DUE THE TOWN OF RIPLEY, OKLAHOMA, A MUNICIPAL CORPORATION FOR GAS, WATER, SEWER SERVICE AND/OR REFUSE COLLECTION WHICH CUSTOMER MAY NOW OR HEREAFTER APPLY FOR AND RECEIVE AT THE ABOVE PREMISES. THE DEPOSIT WILL BE REFUNDED AFTER DISCONTINUATION OF ALL SUCH SERVICES AND PAYMENT OF ALL SUMS DUE, OR AT THE OPTIONS OF THE TOWN OF RIPLEY.

-IT IS THE CUSTOMER’S RESPONSIBILITY TO APPLY FOR THE PROPER TYPES OF SERVICE. THE UNDERSIGNED APPLICANT CERTIFIES THAT THE APPLICANT HAS READ AND UNDERSTANDS THE TERMS OF THIS AGREEMENT.

-CUSTOMER AGREES TO PAY FOR SUCH SERVICE AT THE RATES, TIMES AND THE MANNER NOW AND HEREAFTER ESTABLISHED BY THE TOWN OF RIPLEY, OKLAHOMA, AND FURTHER AGREES THAT THIS SECURITY DEPOSIT MAY BE APPLIED TO ANY DELINQUENT OR UNPAID CHARGE AT ANY TIME DURING THE COURSE OF SERVICE. UNDER SUCH CIRCUMSTANCES A NEW DEPOSIT MAY BE REQUIRED.

-CUSTOMER AGREES TO COMPLY WITH AND ABIDE BY ALL ORDINANCES, REGULATIONS AND TERMS AND CONDITIONS OF THE TOWN OF RIPLEY, OKLAHOMA, CONCERNING SUCH SERVICES AS MAY NOW OR HEREAFTER ADOPTED. CUSTOMER FURTHER UNDERSTANDS THAT INFORMATION CONTAINED HEREON IS A MATTER OF PUBLIC RECORD AND MAY NOT BE WITHHELD FROM ANYONE WHO PROPERLY REQUEST SUCH INFORMATION.