Utilities Application - Residential

Residential Application for Service

Required Documents

Lease agreement from Landlord (must have renter’s name, address, and landlord’s signature) or proof of home ownership
Photo ID
Document with Social Security Number on it (examples: Social Security Card, bank statement, insurance card)

Applicant Information

Name (Last):

(First):

(MI):

(Maiden):

Service Request Date

SS #:

DL #:

DOB:

Employer's Name and Phone #:

Service Address:

Apt. #:

Mailing Address (if different from Service Address):

Number of Persons Living in Household:

Adult(s):

Children:

Names of Adults:

Property Status:

Rent

Own

Landlord's Name and Phone #:

Location of Previous Address (No. & Street):

Apt. #:

City:

State:

How Long Lived There? List Years and Months:

Local Friend or Relative Not Living at Your Address:

Name (Last):

(First):

Phone #:

Address:

Relation:

Authorized Person

Someone other than applicant who will have the authorization to receive information, change service and/or final bill account. It is not required to have an authorized person listed on your account.

Name (Last):

(First):

Relation:

Contact Information

Home Phone #:

Alternate Phone #:

Cell #:

Auto-Notify #:

The City of Thomasville uses an auto-notify system to provide courtesy payment reminders on your due date to help you avoid late fees and/or disconnection of service. If you do not wish to be notified, please leave the Auto-Notify # field blank.

Email Address:

Additional Information:

I would like to enroll in Paperless Billing (the City of Thomasville will send your bills electronically in lieu of a paper statement).

I would like to receive community updates and information.

Copy of Document Containing SS #:

Copy of Photo ID:

Lease Agreement or Proof of Home Ownership:

Agreement

The City of Thomasville now offers utility deposits based on your soft credit score. A soft credit check does not affect your credit. If you refuse the credit check, you will be required to pay the maximum deposit.

I authorize the City of Thomasville to run a soft credit check to determine the deposit amount for the services I am requesting.

I decline authorization for the City of Thomasville to run a soft credit check and opt to pay the maximum deposit amount.

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 submitted paperwork and confirm employment. I understand that I must update credit information at your request if my financial condition changes. I agree to follow and abide by all rules for utilities services and to pay charges in effect as stated on each monthly bill. If I change service address or add an additional service address, I will be bound by this application. I understand that non-payment of my account will result in discontinuation of service.

Applicant Signature:

Date: