Residential Utility Application

Fill out the form below to apply for telecommunications services with Independence Light & Power. Please refer to www.ilpt.com for complete service descriptions and our terms of service. Contact us at (319) 332-0100 for additional information or if you have any questions. Thank you!

Read In Date *

Month

Day

Year

Applicant Information

First Name *

Last Name *

Applicant Birthday *

Month

Day

Year

Home Phone *

Cell Phone *

Email Address - for updates/outages *

Applicant Driver's License # *

Applicant Driver's Photo ID *

Files must be less than 6 MB.
Allowed file types: jpg jpeg png pdf.

Co-Applicant Information

Co-Applicant First Name

Co-Applicant Last Name

Co-Applicant Birthday

Month

Day

Year

Co-Applicant Driver's License #

Co-Applicant Driver's Photo ID

Files must be less than 6 MB.
Allowed file types: jpg jpeg png pdf.

Co-applicant Phone

Service Address

Street Address *

Address Line 2

City

State

Zip Code

If Renting

Landlord Name

Name of other person(s) living at service address (over 18)

Mailing Address

If different from service address

Mailing Street Address

Mailing Address Line 2

Mailing City

State

Zip Code

Applicant Employment

Applicant Employer *

Applicant Employer Phone *

Applicant Employer Street Address

Applicant Employer Address Line 2

Applicant Employer City

Applicant Employer State

Applicant Employer Zip Code

Co-Applicant Employment

Co-Applicant Employer

Co-Applicant Employer Address Line 2

Co-Applicant Employer Street Address

Co-Applicant Employment City

Co-Applicant Employer State

Co-Applicant Employer Zip Code

Emergency Contact

Name *

Phone Number *

Previous Utility Provider

Company Name

Acknowledgement Of Terms

The undersigned hereby agrees to be financially responsible for the payment of bills presented for utility service provided by Independence Light & Power, Telecommunications. Account holder is responsible for contacting ILPT to have services changed and/or read out.

PLEASE NOTE: A Deposit or Letter of Credit will be required before service can be provided. A copy of your photo ID is also required.

Leave this field blank

Search form

Applicant Information

Co-Applicant Information

Service Address

If Renting

Mailing Address

Applicant Employment

Co-Applicant Employment

Emergency Contact

Previous Utility Provider

Acknowledgement Of Terms