Fill - Free fillable Electric & Water Service Application City of Glenwood (City of Glenwood Springs) PDF form

OFFICEUSEONLY

ServiceConnectDate

Number

Amount

Deposit Date / /

Name on ID

DL#

Bus. Lic #

City of Glenwood Springs

Electric & Water Service Application

DateofApplication___________/____________/_____________

PleaseCheckOne



RENT OWN



plicant’sName ________

Service

Address ________

Mailing

Address

City State

Zip

E‐mail

Address ________ 

Cell# Work# _______________



SSN(lastfourdigits)orEIN



Iunderstandthatelectricenergywillbeprovidedinaccord ancewiththemostcurrentrulesandregulationsoftheCityofGlenwoodSpringsElectricandWaterSyste m.

The rule sandregulationsareavailableforreviewat



theofficeoftheutilityboardortheCityClerk’soffice.I herebyagreetopaypromptlyfortheserviceforwhichI

am billed and further agree that my service may be terminatedafter notice of failure to make such timely



payments. I also understand thatservice may be

disconnected,andthatImaybeliableto criminalproceedingsfortamperingwiththemetermeasuringmyserviceorfortheftofelectricenergyorwater. Additionally,

IunderstandthatI willberequiredtopayareconnectfeeandpossibleadditionalutilityd

epositsbeforeserviceisreconnectedandthatonreferralofmyaccount

forcollection,Iwillbeliableforpaymentofallreasonablecosts,includingcourtcostsandattorneyfees.



gnature Date /

/_______________

101

West 8th Street, Glenwood Springs, CO 81601 * 970-384-6455 * www.cogs.us

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Electric & Water Service Application City of Glenwood (City of Glenwood Springs)

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