TOWN OF WAYNESVILLE
COMMERCIAL APPLICATION FOR UTILITY SERVICE

APPLICATION DATE _____________________________ DATE TO CONNECT ________________________

BUSINESS NAME ____________________________________________ TAX ID #_____________________

PRINCIPAL OWNER ___________________________________ SS # ______________________________

SERVICE ADDRESS _____________________________________________________________________

MAILING ADDRESS ______________________________________________________________________

TELEPHONE # (OFFICE) ____________________________ HOME ________________________________

OWN _______ RENT _______ IF RENTING, NAME OF OWNER ____________________________________

NAME OF PREVIOUS OCCUPANT ___________________________________________________________

DO YOU HAVE A PRIVILEGE LICENSE FROM THE TOWN OF WAYNESVILLE? _________________________

TYPE OF HEAT?  ELECTRIC/BASEBOARD ________ GAS ________ OIL ________ WOOD ______________

HAVE YOU OR CO-APPLICANT HAD UTILITY SERVICE WITH THE TOWN BEFORE? ____________________

          IF SO, WHEN?______________________________________________________________________

MOVING FROM WHERE? __________________________________________________________________

THE UNDERSIGNED AGREES TO THE FOLLOWING CONDITIONS FOR UTILITIES REQUESTED:

1) Utilities are billed monthly and are payable within ten (10) days from bill date.
2) Bills are past due after 25 days.  A late penalty of 1% is added and a delinquent notice is
              mailed to customer.
3) Service will be disconnected if payment is not received by due date of delinquent notice.
4) Any tampering with meters or related equipment is a violation of the law and is subject to prosecution
              and service termination.
5) Deposits will be applied to final bills and the balance, if any, will be refunded.
6) There will be a $20 non-refundable connect charge listed on your first bill as other charges.
7) Applications for service at rented units must have a lease or rent receipt attached.
8) Once utility bills and delinquent notices are placed in the United States Postal box outside our office,
              we are not responsible if not received by the customer.

Signature of Applicant ________________________________________ Driver License _______________