Fillable New Service Application Residential (City of Aztec)

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New Service Application Residential (City of Aztec)

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BROWSE CITY OF AZTEC (NM) FORMS

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CITY OF AZTEC
201 W. Chaco St.
A
ztec, NM 87410
505-334-7670 Office
505-334-7679 Fax
New Service Application – Residential
APPLICANT INFORMATION
Account No: Deposit:
Name:
Date of Birth: Social Security #:
Home Phone: Mobile Phone:
Utility Service Address:
Mailing Address:
City: State: ZIP Code:
Do you? Own or Rent If Renting, List Landlord Name:
Do you have or have you had utility service with the City of Aztec: YES or NO
If Yes, what is the address:
Driver’s License #: State: Marital Status: Married Single Widowed N/A
EMPLOYMENT INFORMATION
Current Employer:
Employer Address: Phone:
City: State: ZIP Code:
CO-APPLICANT INFORMATION, IF SECOND PERSON ON ACCOUNT IS DESIRED.
Name:
Date of Birth: SSN: Phone:
Driver’s License No. Relationship to Applicant:
CO-APPLICANT EMPLOYMENT INFORMATION
Current Employer:
Employer Address: Phone:
City: State: ZIP Code:
Bank Draft
Would you like to have your utility payment drafted out of your bank account each month? Yes No
Email address:
We have the capability to email your monthly utility bill, notifications and city-wide alerts and messages to
Aztec utility customers. Please provide your email address, if you would like to receive your bills and
notifications via email Email address: ___________________________________________________
Go paperless – If you prefer we will not send you a paper bill via the postal service.
Bills will be sent via email only
. Check box if you prefer to receive paperless e-bills
If you fail to update or change an incorrect or invalid e-mail address, you understand and agree that any Communications
shall nevertheless be deemed to have been
p
rovided to
y
ou via the e-mail address we have for
y
ou in our records.
THIRD PARTY CONTACT
Name of a person not residing with you:
Address:
City: State: ZIP Code: Phone:
Relationship:
LIFE SUPPORT DEVICE
Are you or a member of your household currently under a Doctor’s care and have been prescribed a life support
device for in home use where electricity and/or water must be provided 24 hours a day?
Yes No
The undersigned has read and agrees to the following:
I agree to provide the City access to the electric and water meters Monday through Friday, 7:00am to 6:00pm, for
the purpose of reading the meters or for any other action deemed necessary. Plants must be kept pruned to
allow access to meters.
I will advise the Utility Department of changes in my mailing address, phone numbers or any changes related to
this application.
I understand that I am responsible for all changes incurred at the specified address while utility services are in my
name until which time I have notified the City of Aztec Utility Department otherwise.
I hereby apply for service from the City of Aztec and in consideration for furnishing such service I agree to
conform to the rules, regulations and ordinances established by the City. The City of Aztec has set policies
regarding the handling of utility accounts. This policy is available upon completing a Request to Inspect Public
Records.
The information I have provided in this document is true and correct to the best of my knowledge and further
agree to the terms set out above.
Signature of applicant: Date:
Signature of co-applicant: Date:
T
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AUTHORIZATION FOR INFORMATION DISCLOSURE
I, ___________________________________________________ Authorize Do Not Authorize
(print first and last name)
the City of Aztec to notify the Landlord, if electric and/or water service is schedule to be discontinued for non-payment
for the utility service address on this application.
______________________________________________ _____________________________
Tenant Signature Date
FOR UTILITY OFFICE USE ONLY
DESCRIPTION
_________ ON ________________________
DATE
________ / _______ / _______
WO# BY:
L.O.C. from DEPOSIT AMOUNT $
NOTES:
click to sign
signature
click to edit
Utility Information Sheet
Welcome to Aztec, New Mexico!
The City of Aztec provides Electric, Water, Sewer and Trash Service
We appreciate the opportunity to provide you service and look forward to serving you. If we may be of
assistance to you, please call the Utility Department at 334-7670. Our office hours are 7:15 am to 5:00 pm
Monday through Thursday. For after hours emergencies, please call 334-6622.
Billing Information:
You will be billed for the following services:
Electric
Metered
Water
Sewer Trash
Curb-side
Recycling
*Water Base Rate *Sewer Base Rate Waste Water Improvement Fee
* Water and Sewer Base rate are billed separately to Multi Units, such as apartments, duplexes, mobile home
parks, etc.. The Landlord pays for the metered water service (the actual usage).
For billing inquiries, please call 334-7670. Bills are sent out approximately the 25
th
of each month and are due
on the 10
th
of each month. The City of Aztec allows for a 10 day grace period after the due date to make your
payment. Payments received after the 10 day grace period will be considered late and account will be
assessed a 5% late payment penalty on the balance due.
Important! Please note the following:
If a disconnect notice is prepared for your account, a trip charge of $20 will be assessed to your account.
If past due payment is not received prior to the disconnect date stated on the notice, service will be
disconnected.
Once utility services have been disconnected, the total due must be paid in full (including all trip and
reconnect charges) prior to utility service being reconnected.
Utility service disconnected for non-payment will be reconnected on the same day payment in paid full and
received. Reconnect charges are: $20 during office hours; $50 after office hours.
In addition to the above charges, an increased deposit will be required on each utility account disconnected
for non-payment. A deposit will be assessed on the account and will be due and payable, in full, by the
due date of the next billing cycle.
Deposits
Deposits are required for all new connections of utility services for water and electricity. Water Deposit is
$100.00 and Electricity Deposit is $100.00. A residential customer may provide an acceptable utility credit
reference in lieu of the deposit. There is also a setup fee accessed to your first bill of $30.00 this fee includes
your connection charges. On Residential accounts, after 12 months of perfect pay history, the customer may
request the deposit be applied to their account. Commercial and Landlord deposits are $200.00.
Payments
We offer a variety of ways to pay your utility bill. We accept checks, cash, money orders and credit/debit cards
for payment. Please make checks payable to the City of Aztec and include the portion of your utility bill with
your payment. Payments may be made in person, or by dropping it in our drop box located in parking lot
closest to Chaco St., by automatic bank draft, online through our web-site at www.aztecm.gov
or you can mail
a check or money order to City of Aztec, 201 W. Chaco, Aztec, NM 87410
201 WEST CHACO STREET AZTEC, NM 87410 OFFICE: (505)334-7670 FAX: (505)334-7679
www.aztecnm.gov
Returned Check Policy
Returned checks will be assessed a $25 service charge. Returned checks will not be re-deposited! The issuer of the check will be
required to pay the amount of the check plus the return check fee in cash or by money order. If two checks are returned to any City of
Aztec office within a twelve month period, checks will no longer be accepted as payment on the account for one year.
Other Services Offered:
Automatic Bank Drafts – You can elect to have your utility payment automatically taken from your checking or savings
account on the 10
th
of each month, unless the 10
th
falls on the weekend or holiday then it will be the next business day
following the 10
th
. Utility Bills are sent out by the 25
th
of the each month so you will have time to review your bill for any
abnormalities before your payment is drafted from your account. If you wish to sign up for Automatic Bank Draft we will
need a bank draft authorization form completed and a voided check. You can get this form at our office or on our web-site
www.aztecnm.gov.
Budget Billing – After one year of utility billing history you may choose to have your account on budget billing.
How this works is your one year history of utility bills are totaled and divide by 11 months, that amount will become your
budget bill payment. Your account is recalculated every six months and your payment will be adjusted accordingly. To
sign up for Budget billing you can visit our office or our web-site www.aztecnm.gov
.
Utility Rates and Policies – Our rates and policies are available upon request at our office or you can visit our web-site
at www.aztecnm.gov click on City Departments and Utility Customer Services for utility rates.
Park Pavilion Reservations – Park Pavilions can be reserved for birthday parties, class reunions or any occasion that
you may want to hold your event outside. We reserve 8 different park pavilions located at Cap-Walls, Florence, Minium
and Riverside Park and Tiger Park. For more information visit our web-site www.aztecnm.gov
or contact the Utility Office.
Online Utility Bill Lookup and Payment – To view and/or pay your account online you will need internet access, your
Aztec Utility Account number and a pin number. The pin number is the last 4 digits of your social security number or your
tax identification number of the primary person on the account. You can access this option by visiting our web-site at
www.aztecnm.gov
, click on City Departments and Utility Customer Service. Once you have accessed your account there
is an option to change your password.
Financial Assistance – We have a list of many organizations that are able to assist with financial aid for utilities. If you
have unforeseen circumstances that enable you to pay your utility bill and you qualify under their requirement guidelines,
you may be able to receive financial assistance to help you out during difficult times. For a list please contact our office or
our website at www.aztecnm.gov
, click on City Departments and Utility Customer Service.
Recycle Center – The City of Aztec Recycle Center is located at 303 S Ash St. For more information you can call (505)
334-7660 or visit our website at www.aztecnm.gov
click on City Departments, under Parks and Recreations click on
Recycle Center.
Telephone Service
Qwest is the local telephone service provider and can be contacted for new services at 800-244-1111.
Natural Gas Service
New Mexico Gas Company (NMGASCO) provides natural gas services to the consumers in Aztec. NMGASCO handles all new
requests, hook-ups, billing, and disconnections. New Mexico Gas Company can be reached at 1-888-664-2726.
Cable Television Service
Comcast is the local cable television service provider and can be reached at 505-327-6143.
Solid Waste Service
The City of Aztec contracts with Transit Waste for solid waste services. The City requires that every premise have solid waste service.
The solid waste service will be included in your monthly utility bill. For additional questions or if you need a poly cart you may contact
Transit Waste at 505-634-2510.
Area Telephone Numbers
Aztec Chamber of Commerce 334-9551
Aztec Municipal Schools 334-9474
U.S. Post Office 334-6181
Aztec Motor Vehicle Department 334-7690
201 WEST CHACO STREET AZTEC, NM 87410 OFFICE: (505)334-7670 FAX: (505)334-7679
www.aztecnm.gov
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Last Updated Sept 2017
μ
CITY OF AZTEC
Scheduled Pickup of Trash
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Completed 20 August 2021

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