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?Required

Yes

Company Name:Required

EIN:Required

Service Address:Required

CityRequired

State:Required

Zip:Required

Billing Address:Required

Local Contact:Required

Phone Number:Required

Fax Number:Optional

Business Description:Required

Home Office Address:Required

City:Required

State:Required

Zip:Required

Home Office Contact:Required

Phone:Required

Fax:Optional

Service Request Date:Required

Name of Bank:Required

Bank Address:Required

Copy of Photo ID:Required

Copy of W9 or Social Security Card:Required

Proof of Occupancy (signed lease/purchase agreement):Required

Certificate of Occupancy (if located within city limits):Optional

Company Owners

Type of Business:Required

Proprietorship

Partnership

Corporation

Proprietorship/Partnership

Name:Optional

SSN:Optional

Address:Optional

City:Optional

State:Optional

Zip:Optional

Name:Optional

SSN:Optional

Address:Optional

City:Optional

State:Optional

Zip:Optional

Corporation

President:Optional

SSN:Optional

Phone:Optional

Vice-President:Optional

SSN:Optional

Phone:Optional

Treasurer:Optional

SSN:Optional

Phone:Optional

Secretary:Optional

SSN:Optional

Phone:Optional

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:Required

Date:Required

FOR OFFICE USE ONLY:

Account Number:Optional

Zip + 4:Optional

Deposit Amount:Optional

Postal Route:Optional

Delivery Point:Optional

Commercial Utilities Application – New Service/Transfer Existing Service

Company Owners

Proprietorship/Partnership

Corporation

Commercial Utilities Application –
New Service/Transfer Existing Service