Residential Service Application

RESIDENTIAL APPLICATION FOR SERVICE

Use the form below to apply for water and sewer service for Residential Accounts. For Commerical Customers use our Commercial Application Form

Security Deposit

A $125.00 deposit is required at the time of this application to establish service. This deposit will not bear interest and will be deposited into the general fund account of the City of Cumming.

If you plan to move from this location or wish to terminate your service, it is YOUR RESPONSIBILITY to notify the City of Cumming Department of Utilities of the day that you wish to terminate service via the City’s Service Termination Form. Your service will be terminated and your meter will be read on that day.

A final bill will be generated and sent to you during the next billing cycle. The $125.00 deposit will be applied to the final bill. Please provide the Department of Utilities with a forwarding address so that the final bill and/or refund will be mailed to the proper person.

If you are moving to another residence within the City’s service area and currently have a $50.00 deposit on file with the City, you will be required to pay an additional $75.00 to transfer service to the new residence. Your previous deposit of $50.00 will be added to the $75.00 and your account will then reflect a $125.00 deposit.

Senior Citizens:

If you provide the Department of Utilities with proof of your age and if you qualify (age 62 or older), you will receive a discount on the water portion only of your utility bill. If you have questions regarding the City’s Senior Citizen discount, please request a current water, sewer, and garbage rate chart from the Department of Utilities.

Delinquent Bill and Returned Check Policy:

If you fail to pay your utility bill and the bill is 60 days past due or if your bill is over $45.00 and past due, your service will be disconnected without notice. In order to have your service restored, you must pay your account balance in full and the City’s DISCONNECTION charge of $40.00. It is the City’s policy to terminate service without notice in response to all returned checks. A service charge of $25.00 plus the $40.00 disconnection fee will be charged for all returned checks.

Bad Debt:

If you file for bankruptcy and are unable to pay your bill, you will be required to re-establish service and pay an additional (new) deposit of $125.00.

If you vacate the premise and your deposit does not cover your final bill, the City will pursue collection of the remainder of the debt and may turn the account over to a collection agency, report each delinquent account to each of the three credit bureaus, and/or file a lien against your property.

Other legal action may be pursued by the City in an effort to collect the debt. Be advised that failure on your part to receive a utility bill does not excuse non-payment. In all cases, nonpayment will result in termination of service without notice.

NOTICE:

In order to complete your request to establish water and/or sewer and/or garbage service, you must submit a copy of your Drivers License or a Georgia Photo ID along with either Proof of Ownership of the property (deed) or a Rental/Lease Agreement along with this completed form.

If you have any questions please contact Cumming Utilities at 770-781-2020.

Cut-On Date: [esigcf7 formid="6856" field_id="date-connect" ]

Full Name : [esigcf7 formid="6856" field_id="account-name" ]

Primary Contact Phone Number: [esigcf7 formid="6856" field_id="primary-phone-number" ]

Secondary Phone Number (Optional): [esigcf7 formid="6856" field_id="secondary-phone-number" ]

Email: [esigcf7 formid="6856" field_id="email" ]

Service Address: [esigcf7 formid="6856" field_id="service-address" ]

Mailing Address (if different than Service Address): [esigcf7 formid="6856" field_id="mailing-address" ]

Subdivision Name & Lot Number: [esigcf7 formid="6856" field_id="subdivision-name" ]

Landlord Name and Phone (if leasing): [esigcf7 formid="6856" field_id="landlord-name" ]

Preferred Billing Method: [esigcf7 formid="6856" field_id="paperless-billing" ]

Senior Citizen Discount: [esigcf7 formid="6856" field_id="senior-discount" ]

MUST BE INITIALED BY ACCOUNT HOLDER TO RECEIVE DISCOUNT: [esigcf7 formid="6856" field_id="senior-initials" ]

Image of your current driver's license: [esigcf7 formid="6856" field_id="drivers-license" ]

Image of Proof of Ownership or Rental/Lease Agreement: [esigcf7 formid="6856" field_id="ownership-lease-agreement" ]

I HAVE READ, UNDERSTOOD AND AGREED TO THE ABOVE TERMS:

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May 24, 2019 11:13 am EDT

Residential Service Application Uploaded by Cumming Utilities - steven@joomlahostingreviews.com IP 73.82.246.63

May 24, 2019 11:30 am EDT

Cumming Utilities - applications@cummingutilities.com added by Cumming Utilities - steven@joomlahostingreviews.com as a CC'd Recipient Ip: 73.82.246.63