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Utilities Business Application - Business App

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400 S. Main St., Suite 109 Cul
p
e
p
er, VA 22701
CUSTOMER NUMBER
LOCATION NUMBER
TRASH CART
AMOUNT PAID
DATE PAID
INITIALS

Customer Service: 540-829-8220
Fax: 540-829-8239
Email: payonline@culpeperva.gov
Business Account Application
Business Name: DBA:
Business Type:
LLC Incorporated Sole Proprietor Corporation Partnership
Fed. I.D. #:
Type of service: (Check all that apply)
Electric (Deposit of $250) Water/Sewer(Deposit of $50) Water Haul (Deposit of $50) Trash
Utility Service Address:
Culpeper, VA 22701
Mailing address (if different)
Billing Contact: On-Site Contact:
Billing Email: On-Site Email:
Billing Phone Number:
On-Site Contact Phone Number:
Have you had service before with the Town of Culpeper?
Yes No
If yes, when & where?
Date desired service to be connected:
Authorized Signature: Date:
Printed Name: Position Title:

SUBSCRIBED, ACKNOWLEDGED, AND
AFFIRMED BEFORE ME THIS______DAY
OF_____, 20____.
Notary Signature: _____________________
Print Name: __________________________
FOR
DISCONNECTED SERVICES
Electric Breakers and/or Water
Valves must be off.
ADDITIONAL FEES APPLY IF
MULTIPLE TRIP HAS TO BE
MADE.
NEXT BUSINESS DAY
(
CANNOT BE BACKDATED
)
A
pp
lication Fee: $25.00
By signing this document, I have read and understood the terms outlined in the utility billing agreement and the water and sewer line
res
p
onsibilities and
p
rocedures included with this form on the followin
g
p
a
g
es.
OFFICIAL USE ONLY
NOTARY SEAL
NOTARY INFORMATION:
REV08
/
2019
All fees and procedures are subject to change as established and set by the Town Council. It is a
condition of the agreement between the Town and the applicant for utility services that the Town shall not be
considered a guarantor with respect either to the continued or uninterrupted supply of such services
contemplated in this application.
All Social Security numbers provided herein will be used for the sole purpose of complying with the State of
Virginia's Set -Off Debt Collection Act (section 58.1-520 et seq) The Town of Culpeper's authority to request
Social Security numbers as part of the Town's Utility Application derives from Code of Virginia section 58.1-521,
Code of Virginia section 2.2-3808 (A) (2) (I) (ii) and the Federal Privacy Act of 1974 section 7(b).
o The disclosure of your Social Security number as part of the Utility Application process is
voluntary. No applicant for utility services will be denied the provision of utilities because of their refusal
to disclose his/her Social Security number. If the applicant does not provide a Social Security
number, two (2) other forms of government identification will be required. Acceptable forms of
government identification include:
Green card
Passport
T-number
(number/card issued
by the IRS so that
they can pay taxes)
Valid state
issued driver’s
license
Valid state issued
identification card
If you do not receive your bill by the third working day after the billing date, there may be an error in
postal delivery, and you should contact the Treasurer's Office to receive a duplicate and/or find out the
amount of your bill so it can be paid by the due date.
If you do not pay your bill by the due date, a penalty of $1.50 or two percent (2%) of the billed amount, whichever
is greater, will immediately be due and payable on your bill. If a bill is not paid in full 10 days after the due
date, a delinquent charge shall be added to the account and services will be DISCONNECTED WITHOUT
FURTHER NOTICE.
o Once a service HAS BEEN PROCESSED FOR DISCONNECT, a $50.00 reconnection fee MUST
BE PAID TO THE TREASURER'S OFFICE.
o An after hour’s fee shall apply to reconnection of disconnected services for non-payment after
normal business hours.
Additional fees are added on all returned checks.
If a deposit for services has been made, the customer consents to the application of such deposit by the Town
Treasurer, or as much thereof as may be necessary, to the payment of any proper bill owed for such services
remaining unpaid.
If a balance is owed upon final termination of utility services and it is not paid within one month of
Rendering the bill, the customer agrees to pay the delinquent bill, all applicable service charges (a service
charge of .0083 per month will be added to the unpaid balance on account 30 days and over -10 percent per
annum), and reasonable attorney's and/or collection fees necessary to collect said bill. A customer may request
in writing, that his deposit be refunded once he has established good credit by paying his bill by the due date at
the same location for a period of two (2) years for residential and five (5) years for commercial customers.
In the event a customer moves, it is his responsibility to make arrangements with the Town to get a final
meter reading. The bill generated from this final reading will be marked FINAL BILL. The final bill will be
deducted from the deposit (if any), and the balance of the deposit will be refunded to the customer or he will be
notified at the last known address if a balance is due on the account.
If a customer leaves one place of service and moves to another Town service area and fails to pay the
remaining billed amount on the former service plus all applicable penalties, delinquent charges, and fees
by the delinquent date, then the new service is subject to immediate disconnection.
Payments may be mailed to the TREASURER'S OFFICE, placed in th
e drop box, which is provided for your
convenience outside the Municipal Building at 400 South Main Street, or by our website, www.culpeperva.gov
and selecting the “pay online” option.
Partial or late payments will not be accepted by the banks. When choosing a method of payment, remember
payments will not be credited to the account until they are received by the Treasurer's Office, and the Town will
not be held responsible for cash payments without proper receipt documentation.
IT IS UNLAWFUL FOR ANY PERSON TO REMOVE, TAMPER WITH, OR DAMAGE ANY METER, POLE,
TRANSFORMER OR OTHER APPARATUS OR EQUIPMENT BELONGING TO OR USED BY THE TOWN IN
CONNECTION WITH ITS UTILITY SYSTEMS AS DEFINED IN THE TOWN CODE AND THE CODE OF
VIRGINIA.

UTILITY BILLING AGREEMENT
August2019
TOWN OF CULPEPER
WATER AND SEWER LINE
RESPONSILITIES & PROCEDURES
TheTownofCulpeperhaspreparedthissummarizationofWaterandSewerLineResponsibilitiesandProcedurestoinform
ourwaterandsewerutilitycustomersoftheimportanceofpropermaintenanceoftheutilitylinesontheirproperty,andto
provideguidancetocustomersastowhattodointheeventofawaterorsewerlineproblem.Pleaseretainthisinformation
forfuturereference,andshareitwiththoseresponsibleformaintenanceofthehomeorbusinessproperty.
WATER LINE RESPONSIBILITY
The Town of Culpeper is responsible for the operation and maintenance of all water mains and water service lines from
the water main up to and through, but not past, the water meter box. The Town of Culpeper is responsible for all water
meters, angle valves, meter setters, or other appurtenances located before the meter box. Maintenance of the building
service pipe or water service lateral and plumbing within the building is the responsibility of the Property Owner. The Town
of Culpeper has no responsibility for the water service line or lateral on the customer’s side of the meter box.
As soon as the Town of Culpeper is notified of a water leak, it will determine whether the leak is the responsibility of the
Town, as described above. If the leak is the Town’s responsibility, it will be repaired without cost to the customer. If the
leak is found not to be the responsibility of the Town, the customer will be notified to make arrangements for repair by a
plumber at the customer’s expense. The Town of Culpeper will not reimburse the customer for the cost of a plumber or
contractor.
Refer to Town Code Sec. 24-77 for additional information. Any changes to Town Code supersedes the information in this
document. It is the customer’s responsibility to be aware of Town Code changes that may affect their liability.
COURTESY ADJUSTMENTS FOR LEAKS
In the event of a water leak, the customer shall immediately notify the Town of Culpeper at (540) 829-8220. The Town of
Culpeper is not responsible for payment or reimbursement for any work that is done on private facilities.
As a courtesy, the Town of Culpeper offers a billing adjustment for unusually high water consumption due to leaks that
have been repaired in a timely manner once identified. Requests for adjustments must be made to the Utility Billing
Division of the Town Treasurer’s Office within 90 days of the repair. Customers are required to provide a description of
the leak, proof of repair, and other relevant information. Customers should receive acknowledgement of their request
within one week.
Requests related to leaks found in the home are limited to once per year, per customer, per location. Where possible and
appropriate, adjustment related to internal leaks are calculated by crediting 50% of the water and sewer consumption
charges in excess of your average use over the past year.
Requests related to external leaks, such as a leak in the service line to a home or irrigation system, are limited to once
per year, per customer, per location. Where possible and appropriate, adjustments to external leaks are calculated by
crediting 50% of the water consumption charges in excess of your average use plus 100% of the sewer consumption
charges in excess of your average use.
The billing period for all adjustments is limited to the highest bill during the three-month period prior to the repair being
completed.
COURTESY ADJUSTMENTS FOR POOLS
The Town of Culpeper offers a courtesy billing adjustment once a year on sewer consumption charges associated with
filling a pool. As water used to fill a pool typically does not enter the sewer system, adjustments are calculated by crediting
100% of the sewer consumption charges related to filling the pools. Requests for adjustments must be made to the Utility
Billing Division of the Town Treasurer’s Office. Customers are required to provide documentation of their pool capacity.
Requests must be made prior to the pool being filled. Customers should receive a response to their request within one
week.
August2019
SANITARY SEWER RESPONSIBILITY
The Town of Culpeper is responsible for the operation and maintenance of all sanitary sewer mains up to the point of
connection with the customer’s sanitary sewer lateral or service line. Sewer stoppages in sanitary sewer mains will be
cleared by the Town of Culpeper regardless of cause. The maintenance of sanitary sewer laterals and service lines is the
responsibility of the customer as they are used exclusively by the customer(s) to connect to the Town of Culpeper’s sewer
mains. By definition, a sanitary sewer lateral extends from the connection with the public sewer main all the way to the
customer’s point of use, including the connection itself.
When a blockage occurs in a sanitary sewer lateral or service line, it is the customer’s responsibility to clear any blockage.
The Town of Culpeper has no responsibility for maintenance, repair or replacement of sanitary sewer laterals or service
lines.
SANITARY SEWER RESPONSIBILITY, PRIOR TO ACCEPTANCE INTO TOWN SYSTEM
The Town of Culpeper is not responsible for the operation and maintenance of sanitary sewer mains that have been
constructed and placed in operation but not yet accepted by the Town of Culpeper. The Property Owner or Developer
retains operating and maintenance responsibility as well as liability for sewer backups within areas served by sewer mains
that have not yet been accepted by the Town of Culpeper. When customers are affected, the Town of Culpeper may, at
their sole discretion, assist in the operation and maintenance of sewer mains that are constructed but have not been
accepted by the Town of Culpeper.
SANITARY SEWER BACKUP
If a customer experiences a sewage backup, the Town of Culpeper should be contacted by calling (540) 825-0285 during
business hours or (540) 825-3039 after hours. A representative will be dispatched to determine if the blockage is in the
main. If the Town determines that the main is clear, the customer will be notified that the blockage is their responsibility
and the services of a plumber or contractor should be obtained. The Town of Culpeper will not reimburse the customer
for the cost of a plumber or contractor.
RESPONSIBILITY FOR CLEANUP AND DAMAGE RESULTING FROM SEWAGE BACKUP
The Town of Culpeper is not liable for any sewage backups caused by factors or conditions beyond the control of the
Town. The Town of Culpeper is only responsible for cleanup and property damage if the damage is a result of a sewer
main malfunction, blockage or backup where the Town of Culpeper is legally negligent.
Any cleanup or repairs required to a building as the result of a sewage backup are the responsibility of the
customer or property owner at the customer’s or property owner’s expense and should be filed with the
homeowners or business property insurance coverage provider, as appropriate. Insurance coverage limitations
vary from policy to policy. It is the customer’s and/or property owner’s responsibility to insure they have
adequate insurance coverage to cover their responsibilities.
As a courtesy, with such funds as are appropriated for the purpose, the town will offer to have a cleaning service clean
and disinfect the affected areas at the town's expense, not to exceed $15,000, in the event that a sanitary sewer main
malfunctions, breaks, experiences a blockage, or experiences a surcharged flow, and the result is a backup into a
business or a residence. The town's willingness to offer this assistance shall not be interpreted as an admission of liability;
rather it is designed to protect the health, safety and welfare of the town's inhabitants. The town will only offer this
assistance so long as the impacted business or residence contacts the town before otherwise contracting for this service.
This assistance shall not be available in situations involving sanitary sewer laterals. This service is not guaranteed but
may be offered to reduce the impact of the backup on the affected business or residence. If the customer believes the
Town of Culpeper was liable, the customer should call (540) 829-8290 to speak to the Human Resources Department
who manages the Town’s Risk Management program, and request that an investigation be conducted. If the matter cannot
be resolved, the Town will file a claim with its insurance company who will further investigate to determine if the Town is
liable.
Refer to Town Code Sec. 24-166 for additional information. Any changes to Town Code supersedes the information in
this document. It is the customer’s responsibility to be aware of Town Code changes that may affect their liability.
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Utilities Business Application - Business App

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Completed 12 July 2020

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