Phone: (770) 748-3220 Fax: (770) 748-8962
Email: jrice@cedartowngeorgia.gov
______________________
APPLICATION
1. Applications will not be accepted or water turned on without the following:
a. Picture identification: Driver’s license. State ID, or Passport
b. Rental or lease agreement or ownership paperwork. Note: rental or lease
agreement must contain the owners name, signature, and telephone
number.
c. $25.00 temporary service fee
2. Service is temporary and limited to 9 days in one billing cycle. Limit for temporary
service is 2 times per customer at each location without a deposit.
Name:__________________________________________Phone:__________________________
Service Address:_________________________________________________________________
Mailing Address (if different):______________________________________________________
Service Start Date:________________________________________________________________
SSN:________________________________________Birthdate:____________________________
Unlock Only: ☐ Yes ☐ No
Email Address:___________________________________________________________________
I would like to receive my bill by (select one) ☐ U.S. Mail ☐ E-Mail
All water bills are due and payable by the 10
th
of the month, if the bill is not paid by this
date, an automatic 10% late charge will be added to the past due balance and the
total bill amount becomes due before the 25
th
of the month following the billing date.
Applicant is responsible for all charges until service is terminated. Failure to receive a bill
does not entitle delayed payment. There will be a $30 charge for all checks returned.
Service charges established by the City of Cedartown may be added to the customer’s
account to cover the costs of collection efforts.
I understand and hereby agree to the following: (1) falsification of any of the above
information may result in the immediate disconnection of service without notice; (2)
failure to pay account in accordance with the City of Cedartown’s policies will result in
the disconnection of service; (3) all water going through the meter is the customer’s
responsibility; (4) failure to pay final bill will result in account being submitted to
collections – I will as a result, be responsible for all charges and collection costs; (5) no
one living in my household has an outstanding balance owing the City of Cedartown.
