City of Hickory, North Carolina
Utility Billing Policy and Procedures
Appendix 1 – Application for Service – Water, Sewer, and Solid Waste Fee Services
Property and Applicant Information:
1) Full name, mailing address, home telephone and business telephone numbers of
responsible party receiving service (if married, provide name of spouse):
Name:__________________________________
If business, name of contact: ______________________________________
If married, name of spouse: _______________________________________
Billing address: _________________________________________________
City ____________________ State _________ Zip _______
Home phone: ____________________ Business phone: ________________
2) Street address of property receiving service:
Street: ________________________________ City: ___________________
Customer Billing Information:
PLEASE NOTE:
A. Utility Charges are the legal responsibility of the above party. A customer
will remain responsible for any utility charges until a properly completed
Application for Termination or Transfer of Service is accepted by a City
of Hickory Collections Customer Service Representative.
B. In addition to legal action against the responsible party, failure to pay such
charges when due may result in disconnection of service.
C. Original bills for Utility service will be mailed to the responsible party, at
the address specified on this form.
Customer’s Approval:
The undersigned certifies that the above billing contact information is correct,
he/she has read and understands paragraphs A, B and C under the section
captioned “Customer Billing Information” and he/she has received the new
customer packet of information detailing our Policy & Procedures.
Print Name: _______________________________________________
Signature: __________________________________________ Date: ______________
For City Use Only:
Customer ID# ____________________ Location ID# ________________________
Employees Initials __________ Date Received _______________________
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