Fillable Town of Surf City Water / Sewer Application (Town of Surf City)

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Town of Surf City Water / Sewer Application (Town of Surf City)

On average this form takes 14 minutes to complete

The Town of Surf City Water / Sewer Application (Town of Surf City) form is 2 pages long and contains:

  • 1 signature
  • 13 check-boxes
  • 46 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Surf City

BROWSE TOWN OF SURF CITY (NC) FORMS

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Office Use Only Date Paid
Received By:
Town of Surf City
Water / Sewer Application ~ Change Form
Applicant Name:
(As name appears on Driver License)
Surf City Address:
Mailing Address:
Phone: Phone 2:
Email: Effective Date:
Service Requested: Water Sewer Garbage (this service is automatically charged to all accounts)
New Owner Owner Tenant Disconnect
Rental Agency:
Agency Contact:
Agency Phone:
Services will be connected when completed application and deposit has been received.
G
uarantee Deposit will be refunded after the final bill has been paid and account has zero balance.
Applications can be sent to the following:
Emailed to: utilities@surfcitync.gov
Faxed to: (910) 328-4132
Mailed to: Town of Surf City Utilities
PO Box 2475, Surf City, NC 28445
Applicant Signature: Date:
Check appropriate Deposit.
$ 150
Deposit
(Pender County)
Account #
$ 50 Deposit
(Irrigation)
Account #
$ 200 Deposit
(Commercial)
Account #
$ 50
Garbage
Only
Account #
Please complete Page 2
Updated May 7, 2020
click to sign
signature
click to edit
Confidential Information
*** DO NOT SEND SOCIAL SECURITY NUMBER BY EMAIL ***
The following information is for collection purposes only.
Services will not be denied for not providing information
Printed Applicant Name:
Date of Birth:
Social Security Number:
Driver’s License: State Number
The Federal Government requires us to collect the following demographic information:
Ethnicity:
Hispanic or Latino Non-Hispanic or
Latino
Race:
American Indian/Alaskan
Asian Black or African
American
Native Hawaiian or Other
White Other
Gender:
Female
Office Use Only
Owner Information
Owner Name: Account #:
Mailing Address:
Previous Account Holder Information
Name:
Account #: Effective Date:
Mailing Address:
Phone:
Final Read: Read Date:
Service Address:
Meter #: Route #: Sequence #:
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Town of Surf City Water Sewer Application (Town of Surf City)

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Completed 16 July 2020

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