Fillable City of Social Circle Application for Utility Services (City of Social Circle, Georgia)

Fill Online, Printable, Fillable, Blank City of Social Circle Application for Utility Services (City of Social Circle, Georgia) Form

Use Fill to complete blank online CITY OF SOCIAL CIRCLE, GEORGIA (GA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

City of Social Circle Application for Utility Services (City of Social Circle, Georgia)

On average this form takes 6 minutes to complete

The City of Social Circle Application for Utility Services (City of Social Circle, Georgia) form is 1 page long and contains:

  • 0 signatures
  • 2 check-boxes
  • 24 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Social Circle, Georgia

BROWSE CITY OF SOCIAL CIRCLE, GEORGIA (GA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
City of Social Circle
Application for Utility Services
To apply for Utility Services, the following items must be submitted:
1. U.S. Driver’s License, Government Issued ID, Passport or Green Card.
2. Lease agreement for either Rental property or Lease or Own Property.
Please print information clearly
For office use only:
Today’s Date:
Representative:
Check if document has been scanned
Date Service Requested: Account No:
Applicant’s Name:
First M.I. Last
Service Address:
Street Address City ZIP
Mailing Address:
Street Address
City State ZIP
Home Phone #: Work Phone #: Cell Phone #:
Customer Email: Receive Email Bills Receive Text/Phone notifications
Driver’s License #: State: Date of Birth (MM/DD/YY):
Nearest Relative: Phone #:
Applicant’s Employer:
Employer’s Address: Employer’s Phone:
Spouse/Roommate:
Employer:
Employer’s Address: Employer’s Phone:
Previous Service Location:
Water Tap Fee: Water CRC Fee: Sewer Tap Fee: Gas Tap Fee: Admin Fee:
Water Deposit Amount: Gas Deposit Amount:
Water Reading: Gas Reading:
Water Ref Customer: Check No: Gas Ref Customer: Check No:
Water Ref City: Check No: Gas Ref City: Check No:
Applicant hereby authorizes the City of Social Circle (the “City”) to use collection agencies to collect past due balances. Applicant agrees to act as
guarantor for any and all payments due and owing the City on this account. As guarantor, applicant further agrees to pay all costs of past due
accounts, including postage, second notices, collection fees, and also reasonable attorney’s fees and court costs if through legal action or an
attorney. Applicant agrees that meters used by the City to measure utility usage can be read incorrectly or can malfunction resulting in a bill to
the Applicant that understates the actual usage. Applicant hereby agrees that the normal statute of limitation, the right to review bills and correct
the errors caused by the operation or reading of a meter shall extend for a period of six years.
I hereby certify that the foregoing information is true and accurate to the best of my knowledge and belief.
Applicant Signature: Date:
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

City of Social Circle Application for Utility Services (City of Social Circle, Georgia)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 5 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document