P.O. Box 549 · 306 East Academy Street · Troy, Alabama 36081
Phone: 334.566.0177 · Fax: 334.808.7404
APPLICATION FOR UTILITIES
(A current driver’s license or other valid form of identification is required for all applicants)
(PLEASE PRINT)
Type of Customer (Check One): Residential Apartment Mobile Home (Check One: New Set-Up Established Set-Up)
Commercial/Industrial Construction (Application must be verified with Licensing & Inspection Dept)
Type of Service (Check One): New Connect Disconnect Transfer Change
Service Property Status: (Check One): Own Rent (Must present a copy of the lease, if renting) Remodel New Construction Other
Account Information
Name of Applicant: Date:
Business Trade Name (if applicable):
Address: Service:
Billing:
Telephone: Billing Contact:
Bank Draft (Please check if you are interested in having your monthly payments debited directly from your bank account.)
Desired Date: Service Connection Disconnect Change
If applicant is a tenant: Landlord’s Name Landlord’s Telephone
Employment Name, Address, & Telephone:
Birth Date:
Drivers License # / SSN / Other ID:
Transfer Information
Transferring From Service Address:
Transferring From Service Account Number:
Desired Transfer Disconnect Date:
Applicant agrees to abide by all City Ordinances & Rules. Service is exclusively for the Applicant. Bills are due and payable in a manner & time
indicated on the bill. Service may be denied without notice for delinquency in payment or violation of law and/or City ordinances, rules or
regulations. Applicant does hereby swear or affirm that all information supplied on this application is complete and accurate.
Applicant Signature: Date
THIS SPACE RESERVED FOR OFFICE USE ONLY
Property Zoning Classification: Is the usage of this property in accordance with the zoning regulations? Yes No
Current City of Troy Business License? Yes No License #
Building Permit
Application Reviewed By:
Date:
Deposit Required: Electric ____________ Water _____________ Garbage ______________ Transfer ___________ Landlord
Deposit Received: Date ___________ Amount_____________ Cash Check (#_______) Credit Card Cashier’s Initials:
Copies attached to application: Current Drivers License Business License Building Permit Lease Other
Application Reviewed By:
Application Received By: Office Mail Fax
The City of
TROY
Utilities
Department
click to sign
signature
click to edit
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