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4. Move In Date
   Move In Date
6. Schiller Park Address
8. City
9. State
10. Zip Code
11. Date of Birth
    Date of Birth
13. First Name
14. Last Name
16. Phone Number
17. Fax Number
19. Email Address
23. Are you the Homeowner?

    1. Yes
    2. No
25. Are you a Tenant/Renter?

    1. Yes
    2. No

29. If you are a renter or tenant, please provide the Landlord's information

31. Landlord Information
33. Landlord First Name
34. Landlord Last Name
36. Landlord Work Phone Number
37. Fax Number
39. Landlord Email
41. Landlord Address
43. City
44. State
45. Zip Code
49. Deposit

    All Schiller Park residents will be asked for a deposit for their utility billing. For residential properties, a deposit of $150 is required and for commercial properties, a deposit of $300 is required. You can either pay the deposit now or it will be included on your first water Bill.

    This deposit will be returned to each resident upon them moving out of the Village of Schiller Park once they pay their Final Water Bill. 

51. Which property type are you renting or owning

    1. Residential Property
    2. Commercial Property
53. Please decide if you would like to pay your deposit now or with your final water bill

    1. Pay it now
    2. Pay it with my first water bill
57. You may upload your Settlement Statement/Lease Agreement and a copy of your photo ID here
59. Upload Here:
60. Upload Here:
62. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
64. Electronic Signature
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

* indicates a required field