UTILITY SERVICE TRANFER FORM
This form is used to transfer utility services for one location to a new location.
DO NOT REPORT EMEGENCIES WITH THIS FORM!
DIAL 9-1-1 FOR ALL EMERGENCIES!
Customer's Full Name (First, Middle, & Last)
Customer's Social Security Number
Customer's email address
Mailing Address for ALL correspondence from this time on (Include City, State Zip)
Day Time Phone Number
Evening Phone Number
Mobile Phone Number
Street Address of NEW SERVICE
Would you like City Water, Sewer, & Garbage service at the NEW LOCATION?Yes No
Date to Start City Services at NEW LOCATION
Would you like Natural Gas service at the NEW LOCATION?Yes No
Date to Start Natural Gas Service at NEW LOCATION
Street address of OLD SERVICE
Account Number of OLD SERVICE (this can be found on your bill; WE MUST HAVE THIS NUMBER TO PROCESS THIS REQUEST)
Would you like you Water Services terminated at the OLD LOCATION?Yes No
Date of Termination of Water Services at OLD LOCATION
Would you like your Natural Gas Services terminated?Yes No
Date of Termination of Natural Gas Services at OLD LOCATION
By electronically signing below in all caps, the customer agrees to be billed a $10.00 transfer charge and to be billed the necessary deposits, if there is no deposit already on account. Generally, there is a $50.00 water deposit required and a $75.00 gas deposit required (if applicable). Deposits for businesses will be more.
Prior to the transfer, termination, or establishment of any City Services, City Hall must receive a photocopy of the Customer's Identification and rent receipt (if a renter establishing services). Please fax the Identification and information to (229) 246-8879 to the attention of the BILLING COORDINATOR.
You must be present at the service location in order to have services connected.
NEW TAPS: If the City's water works, sewer system, or gas system has not already been "tapped" there will be additional charges for these services.
Signature: (type in all capital letters to electronically sign)
Date
