RESIDENTIAL UTILITY APPLICANT INFORMATION

PROPERTY OWNER NAME:

Last Name    First Name    Middle Name

(Optional)  SECOND OWNER:

Last Name    First Name    Middle Name

PROPERTY ADDRESS:

Street Address     Zipcode

PROPERTY OWNER MAILING ADDRESS:

Street Address

City      State    Zipcode

Driver License Number    DL State     Phone   -

Purchase Date   (example 08/17/2016)

Title Company

Previous Owner's Last Name   

Email Address

UTILITY APPLICATION AGREEMENT

I hereby apply and agree to receive the utility services rendered by the City of West Jordan. I agree to abide by the City’s utility service regulations detailed in the Municipal Code Title 9. I agree to pay all charges, fees, interest, and penalties incurred in connection with the City’s rendering such services. I further agree that one or more of these utility services, including water service, may be discontinued when, after notice to me by regular mail, there remains an unpaid balance for any of the utility services furnished by the City.

I understand that utility services will not be commenced or continued at a particular service location if I or my tenant/ occupant at that location is indebted to the City for utility services. If a deposit is required and collected, I consent that upon cancellation of this agreement that all accrued charges may be taken from such deposit, the balance of which shall be refunded to me. I understand it is my responsibility to notify the City of any change in occupancy status and/or billing address.

I understand that before service is commenced or restored I agree to pay all unpaid utility service fees, late charges equal to one and one half percent (1.5%) per month of the unpaid balance which is overdue 30 days or more, including all reconnection costs and reasonable attorney fees incurred to enforce this agreement. I will be responsible for collection fees up to an amount equal the maximum allowed by the State of Utah.

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