New Service Request Utility Service Request and Agreement Utility Service Request and Agreement SERVICE INFORMATION Service Address (required) Service Start Date (required) Owner/Tenant (required) Owner Tenant Owners: Upload Settlement Agreement for Owner Verification APPLICANT INFORMATION Applicant Name (required) Mailing Street or PO Box (required) Mailing City (required) Mailing State (required) Mailing Zip (required) Primary Phone (required) Secondary Phone Email Address (required) * FOR TENANTS ONLY * Upload Lease Agreement Property Management Co or Landlord Phone Number UTILITY AGREEMENT By checking this box, I am signifying that the name provided at the top of this page is my electronic signature and I have read and agree with the following disclaimer: (required)I, the undersigned owner of the above-described property, acknowledge and agree that utility billings are due within thirty (30) days of the billing date. If an account becomes delinquent, a late fee of 1.5% per month will be applied and service may be suspended. If service is suspended, a reconnect fee of $20.00 ($50.00 for after-hours requests) will be required to restore service. I understand that all past due amounts must be paid in full prior to the restoration of utility service. In the event the account is referred for collection, I agree to pay all outstanding amounts, including accrued interest at 18% APR, as well as all applicable collection fees, court costs, and attorney fees incurred in the collection of the delinquent account. OWNER PAYMENT GUARANTEE By checking this box, I am signifying that the name provided at the top of this page is my electronic signature and I have read and agree with the following disclaimer: (required)If the above-described property, owned by me, becomes a lease or rental property, I acknowledge and agree to the following: 1) I will remain primarily responsible for utility service and request that all billings be sent directly to me; or 2) I request that utility billings be sent to the tenant at the service address, while acknowledging that I remain ultimately responsible for all charges. I further understand that if a tenant vacates the property with an unpaid balance, I, as the property owner, am liable for the full amount due. This includes accrued interest at 1.5% per month (18% APR), plus all collection fees, court costs, and attorney fees incurred in the collection of the delinquent account. There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
