NEW SERVICE INFORMATION SHEET

 

 

CUSTOMER NAME___________________________________________________________

 

SOCIAL SECURITY #_________________________________________________________

 

SERVICE ADDRESS__________________________________________________________

 

MAILING ADDRESS (IF DIFFERENT THAN SERVICE ADDRESS)

 

______________________________________________________________________________

 

______________________________________________________________________________

 

HOME PHONE #______________________________________________________________

 

CELL PHONE #______________________________________________________________

 

WORK PHONE #_____________________________________________________________

 

PLACE OF EMPLOYMENT____________________________________________________

 

EMERGENCY CONTACT NAME_______________________________________________

 

RELATIONSHIP TO CUSTOMER______________________________________________

 

EMERGENCY CONTACT PHONE #____________________________________________

 

ADDITIONAL NAME ON ACCOUNT (IF YOUR NAME IS THE ONLY NAME ON THE ACCOUNT, YOU WILL BE THE ONLY PERSON TO RECEIVE INFORMATION ABOUT THE ACCOUNT)

 

NAME_______________________________________________________________________

 

SOCIAL SECURITY #_________________________________________________________

 

RELATIONSHIP________________________PHONE#______________________________

 

DATE YOU WANT TO HAVE SERVICES CUT ON_______________________________

 

††††††† _____ELECTRIC††††††††††††††††††††† _____GAS†††††††††††††††††††††††††††† _____WATER

 

SERVICES REQUESTED (ALL SERVICES WILL BE CONNECTED UNLESS OTHERWISE NOTED)

 

THE CITY OF KINGS MOUNTAIN ACCEPTS NO RESPONSIBILITY BEYOND THE METER

 

SIGNED____________________________________________DATE__________________

 

The social security number will be used to facilitate collection of utilities if you do not timely and voluntarily pay the bills.Using the social security number will allow the City of Kings Mountain to claim payment of an unpaid utility bill from any state income tax refund that might otherwise be owed to you.†† Your social security number may be shared with the state for this purpose.

 

City of Kings Mountain Utility Service Agreement

 

 

The utility bill will be processed and mailed by the 5th business day of each month and will be due by the 20th of each month.Utility accounts with a balance of $10.00 or more after 5:00pm on the 20th of the month will accrue a late fee of 1% of the balance due with a minimum of $10.00.Receipt of payment on utility accounts is due on the last business day of the month by 5:00pm to avoid disconnection of services and a processing fee of $50.00.Once the service(s) is (are) disconnected, the bill must be paid in full for reconnection.To induce the City to accept this application and provide utilities to the customer, the customer agrees to comply with the Cityís rules and regulations and to promptly pay for all utilities received.

 

When youíve paid on your utility account for 12 consecutive months without incurring a late fee your deposit will be credited back to your account.(not applicable to businesses)

 

When you move, you will need to come into the office with a valid picture ID to close the utility account.

 

*Bank Draft is available upon request.Utility accounts are drafted each month on the 20th.Please let your service representative know if you are interested.

 

*If you have gas service, it is the customerís responsibility to have the landlord/homeowner call the gas department (704-734-4516) to set an appointment to have the lock taken off the meter and turned on. The electricity must be on at the property prior to making an appointment. The gas department will only meet the homeowner or a licensed heating contractor to have this done. Appointments made up to 2:00 pm on scheduled work days.

 

* It is the property owner and/or tenantís responsibility to insure that all plumbing fixtures including commodes, sinks, dish washers, and hot water heaters are in good working order and that all valves, faucets, and spigots are closed so not to flood their property or have used a large volume water when the water is turned on.

 

Landfill Charges:This address currently has ______ cans/containers and _____pickups per week at the charge of $__________per month.It is the responsibility of the customer to contact the Public Works Department, (704)734-0735 for any billing questions, changes, and/or container requests.Every customer is billed storm water monthly.

 

 

______________________________________††††††††††††††††††† ________________________

††††††††††† Signature of Customer††††††††††††††††††††††††††††††††††††††††††††††† ††††††† Service Date Requested

 

 

______________________________________††††††††††††††††††† ________________________

††††††††††† Signature of Customer Service ††††††††††††††††††††††††††††††††† ††††††††Service Address

††††††††††††††††††††††††††††††††††† Representative†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††