Application for Utility Service

This is a contract, please read carefully:

The undersigned, referred to as Applicant, hereby agrees to pay all costs of fees and/or properties due under this agreement including, but not limited to, attorney's fees and court costs set by the court, sitting without a jury. If Applicant changes service address or adds an additional service address, they will be bound by this application. The Applicant further agrees to be goverend by the Ordinances pertaining to water sewer and sanitation services provided by the City of Prescott.
The Applicant agrees as follows:
1. A deposit in the amount of (see below) $Deposit Amount is tendered herewith. This deposit is applied to Customer's account after twelve months of acceptable credit. DEPOSIT REQUIRED: $200.00 for single family home. For multi-family residences, non-residential or industrial properties, deposit is calculated on an individual basis to cover at least two (2) months estimated bills. DEPOSIT WAIVED: Letter of credit from an existing utility company. This letter must show current twelve (12) months of on time payments with no more than one (1) late payment.*
2. A non-refundable service fee of $25.00 + tax for the City's technical and administrative services in providing the initial service to the Applicant.
3. Water, sewer and sanitation bills will be computed in accordance with the City's authorized rate schedules, subject to modification by City Council.
4. At such time as Applicant desires to terminate service with the City, not less than one (1) business day notice must be given. A confirmation number will be given on all termination requests made telephonically. Receipt of notice of termination is when it is received at City Hall. An accurate forwarding address must be given to the City for the purpose of submitting a final billing and any remaining amount returned to the Applicant at the forwarding address. Applicant will be responsible for all charges until the City is notified to terminate service.
5. Duly authorized agents of the City shall have access at all times to keep the meter unobstructed and accessible (including, but not limited to, vehicles, vegetation, fencing and debris). After notice, a penalty of $25 will be assessed for each 30-day period the violation remains in effect.
6. Bills are due when rendered and shall be delinquent after 30-days, and if not paid within that time, 1.5% interest per month will be added to the outstanding balance. and service may be disconnected by the City. Water service will be restored when the account, including interest and a service fee of $50.00 plus tax, is paid in full. Failure to receive bills or notices shall not prevent bills from becoming delinquent nor relieve the Applicant of their obligations.
Letter of credit from an existing utility company.

If you are trying to have the deposit waived, you must provide a letter of credit from an existing utility company. This letter must show current twelve (12) months of on time payments with no more than one (1) late payment. You may provide this via email as well or with your form if you are mailing or faxing it in. Uploading a letter does not guarantee that the deposit will be waived as it will need to be reviewed by staff. Please follow the instruction in the email you will receive after submitting this form.
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If this is a rental income property, would you like to receive a landlord agreement?

YesNo
Applicant Signature*

Clear
Date of Birth*

MonthDayYear
Date
Last 4 Digits of SSN *
This will only be used to verify customer identity
Driver's License/ID #*
INCLUDE A COPY OF YOUR DRIVER'S LICENSE OR PHOTO ID IF MAILING OR FAXING. APPLICATION WILL NOT BE PROCESSED WITHOUT A COPY OF YOUR ID.
Driver's License/ID State*
Driver's License/ID Expiration*
Copy of Driver's License/ID

INCLUDE A COPY OF YOUR DRIVER'S LICENSE OR PHOTO ID IF MAILING OR FAXING. APPLICATION WILL NOT BE PROCESSED WITHOUT A COPY OF YOUR ID.
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Phone Number*
Please enter a valid phone number.
Home or Cell?

HomeCell
Work Phone
Please enter a valid phone number.
Would you like to receive e-mail bills?*

YesNoBoth Print and Email
Email*
example@example.com
Second Applicant Signature

Clear
Date of Birth

MonthDayYear
Date
Last 4 Digits of SSN
This will only be used to verify customer identity
Second Applicant Driver's License/ID #
INCLUDE A COPY OF YOUR DRIVER'S LICENSE OR PHOTO ID IF MAILING OR FAXING. APPLICATION WILL NOT BE PROCESSED WITHOUT A COPY OF YOUR ID.
Driver's License/ID State
Driver's License/ID Expiration
Copy of Second Applicant's Driver's License/ID

INCLUDE A COPY OF YOUR DRIVER'S LICENSE OR PHOTO ID IF MAILING OR FAXING. APPLICATION WILL NOT BE PROCESSED WITHOUT A COPY OF YOUR ID.
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Second Applicant's Phone Number
Please enter a valid phone number.
Home or Cell?

HomeCell
Work Phone
Please enter a valid phone number.
Today's Date*

MonthDayYear
Date
ATTORNEY & COLLECTION FEE PROVISIONS FOR APPLICATIONS

COST OF COLLECTION: Applicant agrees to pay any and all costs of collection, including but not limited to, reasonable attorney fees and collection service fees, incurred by the City of Prescott or expended by the City of Prescott Legal Department to collect any delinquent account billings of Applicant.

CORPORATE OFFICER PERSONAL GUARANTY: Undersigned agrees to be personally responsible for all utility billings of applicant together with any and all costs of collection, including but not limited to, reasonable attorney fees and collection service fees, incurred by the City of Prescott or expended by the City of Prescott Legal Department to collect any delinquent account billings of Applicant.

CORPORATE OFFICER PERSONAL GUARANTY
Date

MonthDayYear
Date
Signature of Officer

Clear
Title
Signature of Spouse

Clear
Date

MonthDayYear
Date
Signature of Officer

Clear
Title
Signature of Spouse

Clear

FOR OFFICE USE ONLY
FOR OFFICE USE ONLY
METER READING
ON DATE

MonthDayYear
Date
ACCOUNT ID
CUSTOMER ID
PREV ACCT BAL
DEPOSIT OR LOC
1X FEE BILLED OR PAID
E-BILL OR PAPER
ALT WATER
PER GAL TAX
SEWER USAGE
SAME SVCS
5000/6050
CURRENT READ
AQUIFER FEE
TAXES
TRASH
Should be Empty:

Application for Utility Service

FOR OFFICE USE ONLY