Fillable Utility Services Turn-On Residential Service

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Utility Services Turn-On Residential Service

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pg 1
Utility Services
Turn-On Residential Service
850-891-4968 | Talgov.com/YOU
Signature Date
Signature acknowledges request for all services available and that applicant has read and accepted contract as outlined on page 3.
A copy of applicant’s Driver’s License and Social Security card is required with this application. See page 2 for more information.
Step 3: Select additional free features and community help services.
Address for New Utility Service Apt. No.
Mailing Address (if different from above)
Home Phone Number Cell Phone Number
Email Address Date of Birth
Employer Business Phone Number
Social Security Number Driver’s License Number State
First Name M.I. Last Name Requested Turn-On Date
Step 1: Fill out all information completely. Retain a copy for your records.
Step 2: Select type of service.
Please indicate requested services below. A deposit and a non-refundable service charge are charged for each utility service you are requesting. Service
charges can be billed on your first month’s utility bill. Deposits can be spread over the first three months’ bills in addition to any normal monthly charges.
Type of Service Deposit + Service Charge =
Subtotal
(Select all that apply)
Electric $160.00 $18.50 $178.50
Natural Gas $60.00 $18.50 $78.50
Water (and Sewer where provided) $50.00 $18.50 $68.50
Sewer Only $50.00 N/A $50.00
(Add all applicable subtotals here)
Service Total
>>
Common Service
Combination Totals:
Electric & Water = $247.00
Electric & Gas = $257.00
Electric, Water & Gas = $325.50
It is the responsibility of the customer and property owner to ensure the premise has been inspected and is ready for utility services to be activated. The City of Tallahassee will not be
responsible for any damages to property caused by turning on requested services. To ensure safety we do not turn on natural gas service and provide the initial pilot lighting until a premise is
occupied and a customer is present at the premise.
Deliver my bills electronically with the secure SmartBill. Save time and money.
Update me on outages and other important information by: (select all that apply)
EmailCell phone (voice message) Home phone (voice message)Text message*
*Standard text messaging rates may apply from your wireless provider.
$1/month
Change for Change: I want to help homeless children and families in Tallahassee by donating on my utility bill. (select an amount)
$3/month $5/month Other monthly amount
pg 2
Copy of Driver’s License Copy of Social Security card
Applicant-Person must submit a copy of his or her Driver’s License and Social Security card in the
spaces provided below or on a separate page attached to the application on page one:
pg 3
This contract made and entered into as of the date appearing on page 1 hereof for and in
consideration of utility service furnished to the applicant and monies paid to City by said
applicant.
Definitions: “Applicant” - person applying for services on page 1 hereof. “City” - City of Tallahassee.
1. City agrees to furnish available utilities to applicant at address stated herein and applicant
agrees to take City utilities as available.
2. Applicant agrees to pay for utilities furnished according to the now existing rate schedule or
any rate schedule to become existent in the future.
3. Applicant agrees to conform and abide by all City ordinances dealing with utilities (Chapter
21 Tallahassee Code).
4. Applicant understands and agrees that in the event he or she receives utility services above
deposit, City may require additional deposit, also when service is discontinued by either
applicant or City and deposit is not adequate to pay for services furnished that applicant is
justly indebted to City for excess or in case refund is in order same will be made in due course
to applicant.
5. Applicant understands and agrees that providing there is an unpaid balance due on my, or
our, account for utility service at any other connection it may be transferred to this connection
for immediate payment.
6. Agents signing this application on behalf of principals hereby agree to be jointly and severally
liable with their principals under the terms of this contract.
7. Applicant hereby agrees to pay the City’s costs of collection, as often as such costs may be
incurred, of any amounts which may become payable to the City for utility services but which
are not paid when due. Such costs shall include, but not be limited to, fees charged by a
collection agency, attorney’s fees, and court costs.
8. City collects your Social Security Number (SSN) for the following purposes: classification
of accounts; customer identification and verification; customer billing and payment;
creditworthiness; and other lawful purposes necessary in the conduct of City business (Section
119.071(5) (a)6, Florida Statutes).
9. City may release your SSN to commercial entities as required by law (Section 119.071(5)
(a)6, Florida Statutes).
updated: 4/29/20
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Utility Services Turn-On Residential Service

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Completed 30 July 2020

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