APPLICATION FOR UTILITIES
(A current Driver’s License and Social Security Number is required for all applicants)
The City of Troy is committed to ensuring that your information is secure. In order to prevent unauthorized access or disclosure,
we have put in place suitable physical, electronic, and managerial procedures to safeguard and secure the information we collect.
Deposit (refundable) & Connection Fee (non-refundable) charges: Electricity & Water = $180 Electricity Only = $145 Water Only = $45
Please see our Utility Rate Schedule for complete breakdown of charges and fees.
ACCOUNT INFORMATION (Applicant must be 18 years of age or older)
Name of Applicant:____________________________________________________________ Date:________________________
Business Name (if applicable):________________________________________________________________________________
Applicant’s Phone No: Email:__
Date of Birth:___________________ Drivers License #/Other ID:________________ Social Security #/Tax ID:
Desired Date for Service Connection:______________________ Landlord’s Name if renting:______________________________
Service Address:___
Billing Address:___
Emergency Contact: Emergency Phone No:
£ I authorize the City of Troy to obtain information from my personal credit profile solely to confirm my identity and
determine my deposit requirements. (Social Security number is required)
£ I am interested in having my monthly payments debited directly from my bank account on the 10
th
of each month
through Automatic Bank Draft.
All bills will be paperless unless a paper copy is requested by applicant.
________________________________________________________________________________________________
**Please be aware of the following in regard to discontinuance of service when applicable: **
Pursuant to Sec. 13-10 of the City of Troy Code of Ordinances, requests for disconnection must be submitted in writing and are not
accepted over the phone. If an account holder fails to notify the City of disconnect, they will continue to be responsible for all charges
until service is placed back into the owner’s name or a new occupant requests service.
________________________________________________________________________________________________
Applicant agrees to abide by all City Ordinances & Rules. Service is exclusively for the Applicant. Bills are due and payable in a manner & time
indicated on the bill. Service may be denied without notice for delinquency in payment or violation of law and/or City ordinances, rules or
regulations. Applicant does hereby swear or affirm that all information supplied on this application is complete and accurate.
Applicant Signature Date
THIS SPACE RESERVED FOR OFFICE USE ONLY
Deposit waived: £ Yes £ No
Application Reviewed By:______________________ Application Received By: £ Office £ Mail £ Fax £ Other_______________
301 Charles W. Meeks Avenue · PO Box 549 · Troy, Alabama 36081 | Phone: 334.566.0177 | Fax: 334.808.7404
Email: customerservice@troyal.gov | www.troyal.gov
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