Application for Residential Utility Service

Bainbridge Municipal Utilities

Primary Name ______D.L.______SS ______

Secondary______D.L.______SS ______

Mailing Address ______City______State____Zip ______

Previous Address ______City______State____Zip ______

Telephone______Cell Phone ______

Utility Service Address ______

Utility Service RequestedWater ______Gas ______Electric ______Sewer ______

Requested Utility Connection Date ______

Property Status:

______Own/Contract______Rent______Landlord ______phone

(if applicable)

______

Employer (Primary)Employer (Secondary)

______

Employer AddressEmployer Address

______

Employer PhoneEmployer Phone

Emergency Contact ______Telephone Number ______

OFFICE USE ONLY

Account # ______Deposit # ______

Water $50.00

Sewer $50.00

Electric$75.00Total Deposit Amount______.00

Total Electric$150.00

Gas$125.00

***SIGN AND DATE BACK OF APPLICATION

*effective June 1, 2017

Terms and Conditions of Utility Service

Bainbridge Municipal Utilities

  1. Meter deposits shall be retained for ten (10) days after the final usage bill has been paid in full.
  1. Utility Billing will be mailed by the 10th day of each month. Payment is due by 4:00pm on the 30th day of each month. Payment is due by 4:00pm the next business days if the 30th falls on a weekend or holiday.
  1. A 10% penalty is assessed to all accounts that become delinquent. Notification of the disconnect date will be mailed on the day accounts become delinquent. The customer will be notified that payment must be received within seven (7) days to prevent disconnection.
  1. A reconnect fee of $20.00 will be assessed for each utility that has been involuntarily disconnected. This fee, along with the payment of entire balance is required before utility service will be reconnected.
  1. All payments from customers shall be applied to the oldest outstanding balance.
  1. One extension of payment time may be granted in any 12-month period. The customer must sign a written agreement and a minimum payment of 25% is due upon signing. Extensions shall not extend past the 28th of each month. **
  1. Customers must keep all utility meters accessible to utility employees at all times.
  1. Utility customers are responsible for all reasonable attorney fees and costs associated with the collection of unpaid utility accounts. This includes 8% for interest in unpaid utility costs.

I, ______and I, ______fully understand terms and conditions set forth by the Bainbridge Municipal Utilities.

______

Signature DateSignatureDate

**effective July 13, 2017