Fillable UTILITY SERVICE APPLICATION (City of Montgomery)

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UTILITY SERVICE APPLICATION (City of Montgomery)

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The UTILITY SERVICE APPLICATION (City of Montgomery) form is 3 pages long and contains:

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  • 16 check-boxes
  • 18 other fields

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FOR OFFICE USE ONLY
Employee Signature:
Processed Date:
Total Amount Paid:
Meter Read:
SERVICE ADDRESS: Residential Commercial
ACCOUNT NAME: Owner Tenant
EMAIL:
MAILING ADDRESS:
DRIVERS LICENSE:
PRIMARY PHONE: Cell Work Home
SECONDARY PHONE: Cell Work Home
IMPORTANT: An account holder may request their personal information be kept confidential. If an account holder
makes such a request of confidentiality, the City of Montgomery shall keep their personal information confidential
unless required or mandated by law.
Yes, request confidentiality No, do not request confidentiality
UTILITY SERVICE APPLICATION
City of Montgomery
101 Old Plantersville Rd, Montgomery Texas 77316
(936)-597-6434 www.montgomerytexas.gov
I understand that I am responsible for my City of Montgomery Utility bill each month until the City of
Montgomery has received a completed disconnect application for my account.
I understand that failure to receive a bill does not remove the responsibility to pay the amount due by the due
date.
★
TO COMPLETE APPLICATION, ATTACH COPY OF DRIVERS LICENSE AND DEED OR LEASE AGREEMENT.
★
Applicant Signature:
Date Completed: Print Name:
Application Fee: $30.00
Deposit: Residential Homeowner: $125.00 Residential Tenant: $225.00
Commercial Owner: $250.00 Commercial Tenant: $250.00
(OFFICE USE)
Account Number:
click to sign
signature
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Welcome to The City of Montgomery!
Residential Garbage:
The Green can is for Garbage and the Yellow can is for Recycling.
Both cans must be out by 7am and spaced approximately 4 feet apart from each other with lids
closed.
Trash days are Wednesday every week. There are separate trucks for Garbage and
Recycling.
It is the Resident’s responsibility to verify the number of cans you are being billed for is correct.
If your Garbage or Recycling is missed, please leave your trash can(s) at the curb and call the
Utility Department at (936)-597-3275 on the following Thursday so we can send the truck back
out to collect.
If you are missing a can or your can becomes damaged, please call the Utility Department at
(936)-597-3275.
Billing:
Your monthly bill will be mailed to you at the mailing address you provide.
You can pay your bill by Phone, Dropbox, Mail, Online, or at City Hall with:
o Cash, Check, Credit/Debit Card, or Money Order
Bills are due monthly between the 15
th
-19
th
. The billing cycle runs from the 17
th
of the previous
month through the 17
th
of last month.
Late notices are mailed the business day following the due date. Water cutoffs are done on
the first Wednesday of each month.
ACH Draft:
It is optional to fill out and return the attached ACH Draft form. If you wish to be on Automatic
Draft, please fill out the form, attach a voided check and return to City Hall.
You will still receive a bill in the mail, for your records, showing the amount that will be drafted,
date of draft, due date and your monthly usage.
Irrigation (if applicable):
If your property has an irrigation system, you may need to check the system settings and
adjust to your watering preferences.
* I acknowledge that I have read and understand the above listed information.
Applicant Signature:
Date: Print Name:
If you have any questions or concerns, please call the City of Montgomery Utilities Department at
(936)-597-3275.
UTILITY INFORMATION PAGE
City of Montgomery
101 Old Plantersville Rd, Montgomery Texas 77316
(936)-597-6434 www.montgomerytexas.gov
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signature
click to edit
ATTACH VOIDED CHECK HERE
FOR OFFICE USE ONLY
Employee Signature:
Processed Date:
(OFFICE USE)
Account
Number:
What is an ACH Draft? ACH Draft lets you authorize the payment of your Utility Bill directly from your
Bank Account.
How will I know the amount being deducted from my account? You will still receive a copy of your
bill for your records. If you have any questions or concerns regarding your bill, please contact the Utility
Department at (936)-597-3275.
When will my bill be paid? ACH Draft is deducted from your bank account the business day before
the due date.
I authorize The City of Montgomery to initiate entries to my bank account at the financial institution (First Financial
Bank), and if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in
effect until The City of Montgomery is notified by me in writing to cancel the agreement in such time as to afford The City
of Montgomery and financial institution a reasonable opportunity to act on it. To avoid a late charge, it is your
responsibility to inform the City of Montgomery of a change to your bank account information.
Applicant Signature:
Date Completed: Print Name:
SERVICE ADDRESS:
NAME ON BANK ACCOUNT:
FINANCIAL INSTITUTION:
BANK ROUTING #:
BANK ACCOUNT #:
UTILITY ACH/ BANKING AGREEMENT
City of Montgomery
101 Old Plantersville Rd, Montgomery Texas 77316
(936)-597-6434 www.montgomerytexas.gov
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UTILITY SERVICE APPLICATION (City of Montgomery)

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Completed 14 July 2020

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