Fillable NotificationofUtilityServiceSetUp/CutOff SendCompletedFormtoFinanceDepartment,Attn:AccountsPayable NewServiceRequest CutOffServiceRequest DepartmentContactPerson Phone# ServiceProvider/VendorName (Mac

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NotificationofUtilityServiceSetUp/CutOff SendCompletedFormtoFinanceDepartment,Attn:AccountsPayable NewServiceRequest CutOffServiceRequest DepartmentContactPerson Phone# ServiceProvider/VendorName (Macon-Bibb County, Georgia)

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The NotificationofUtilityServiceSetUp/CutOff SendCompletedFormtoFinanceDepartment,Attn:AccountsPayable NewServiceRequest CutOffServiceRequest DepartmentContactPerson Phone# ServiceProvider/VendorName (Mac form is 1 page long and contains:

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  • 10 check-boxes
  • 31 other fields

Country of origin: US
File type: PDF

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NotificationofUtilityServiceSetUp/CutOff
SendCompletedFormtoFinanceDepartment,Attn:AccountsPayable
Emailcompletedformto:utilityrequest@maconbibb.us
NewServiceRequest Cut‐OffServiceRequest
DepartmentRequestingService Date:
DepartmentContactPerson Phone#
ServiceProvider/VendorName
LocationofNewService/ServiceAddress
Name
Address
DateNewServiceRequested
OR
DateofTransferbacktoMBC
OR
DateCut‐OffRequested
BudgetAccount#tobecharged
ReasonforServiceChange
DepartmentHeadSignature
CountyManagerSignature
8/15/18
ForOfficeUseOnly
BusinessLine Centrex
DICode:_______________________
AccountNumber:
478‐751‐7000
478‐U14‐2061061
478‐U67‐0065311
PICCode:____0377______________
LocalContact:___________________
AlternateContact:_______________
TaxForm
TypeofPhoneService
FaxLine
RingDownCircuit
LongDistanceService
RepairService/CutLine
Estimated Annual Recurring Savings (for disconnections)
Notification of Utility Service Set Up/Transfer/Cut Off
Department is responsible for obtaining all signatures and submitting form to email address below
Select one
box per
request
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New Service Request
Transfer Request
Cut-Off Request
AT&T
For IT Office Use Only
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NotificationofUtilityServiceSetUpCutOff SendCompletedFormtoFinanceDepartment,Attn:AccountsPayable NewServiceRequest CutOffServiceRequest DepartmentContactPerson Phone ServiceProviderVendorName (Macon-Bibb County, Georgia)

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Completed 24 July 2021

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