Utilities Application - Commercial

Commercial Utilities Application –
New Service/Transfer Existing Service

We will contact you once we receive your application.

For customers wishing to utilize a bond from their insurance company in lieu of cash deposits, please contact our office at (229) 227-7001 for additional assistance.

Please note: City of Thomasville Utilities collects your social security number for the following purposes: clarification of accounts; customer identification and verification; customer billing and payment; creditworthiness; and other lawful purposes necessary in the conduct of business.

Is your business a certified Family Violence Shelter/Agency recognized by the State of Georgia?

Yes

Company Name:

EIN:

Service Address:

City

State:

Zip:

Billing Address (if different from Service Address):

Local Contact:

Phone Number:

Fax Number:

Business Description:

Home Office Address:

City:

State:

Zip:

Home Office Contact:

Phone:

Fax:

Service Request Date:

Name of Bank:

Bank Address:

Copy of Photo ID:

Copy of W9 or Social Security Card:

Proof of Occupancy (signed lease/purchase agreement):

Certificate of Occupancy (if located within city limits):

Company Owners

Type of Business:

Proprietorship

Partnership

Corporation

Proprietorship/Partnership

Name:

SSN:

Address:

City:

State:

Zip:

Name:

SSN:

Address:

City:

State:

Zip:

Corporation

President:

SSN:

Phone:

Vice-President:

SSN:

Phone:

Treasurer:

SSN:

Phone:

Secretary:

SSN:

Phone:

I certify that everything that I have stated on this application is true to the best of my knowledge. I authorize you to check my credit, employment, or business ownership and to answer questions others may ask you about my credit record with you. I must update credit information at your request if my financial condition changes.

Applicant's Signature:

Date:

FOR OFFICE USE ONLY:

Account Number:

Zip + 4:

Deposit Amount:

Postal Route:

Delivery Point:

Commercial Utilities Application – New Service/Transfer Existing Service

Company Owners

Proprietorship/Partnership

Corporation

Commercial Utilities Application –
New Service/Transfer Existing Service