Barrett, Minnesota A picturesque village nestled in a valley in West Central Minnesota

New Account Application


Street Address



Mailing Address________________________________________


Telephone Number_______________________________________________

Alternative Number_______________________________________________

Please provide the following information so that The City of Barrett complies with Federal Law prohibiting discrimination on the basis of race, color, or national origin.  You are not required to furnish this information, but are encourage to do so.  This information will not be used in evaluating your request for service or to discrinimate against you in any way.  However, if you choose not to furnish this information, we are required to note your race/color/national origin on the basis of visual observation or surname.

Racial Categories (check all that apply)                   Ethnic Categories (check all that apply)
_____American Indian or Alaskan Native             _____Hispanic or Latino
_____Asian                                                                 _____Not Hispanic or Latino
_____Black or African American
_____Native Hawaiian or Pacific Islander

310 2nd Street, PO Box 155, Barrett, MN 56311 320-528-2440 email -