Residential Application for Utility Services

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Desired service start date
Service Address
Customer Name
Are you the owner?
Click or drag files to this area to upload. You can upload up to 2 files.
Landlord / Manager Name
Is there a Co-Applicant?
Mailing Address (if different than above)
Reference #1 Address
Reference #2 Address
Address
Consumer Responsibility Agreement
Payment:
The applicant agrees to pay monthly for the utility services rendered by the City of Santa Clara. Charges for service will be made at the regular established rates for the class of service applicable. The city shall forward a bill as a courtesy. Payment responsibility remains with the applicant whether bill is received or not.

Delinquency:
Payment for services is due monthly by the 20th and shall become delinquent if not paid by that date. A penalty of 10% of the unpaid balance will be added to delinquent accounts. The City shall terminate service on delinquent accounts not paid after notice. To restore service, the customer must bring current all delinquent charges. The City will also charge a reconnection fee.

Security Deposit:
The applicant is required to pay a deposit. The deposit is not considered a prepayment of any bill. Unpaid accounts will be considered delinquent regardless of the deposit. The City will apply the deposit to the final bill. Any balance remaining will be refunded to the customer.

Reasonable Access:
The applicant shall permit the City’s authorized representatives to enter the customer’s premises at all reasonable times for purposes related to rendering, billing, or disconnecting utility services.

Termination of Services:
The applicant agrees to be responsible for payment of utility charges until one of the following occurs:
By mutual agreement in writing signed by both the City and the applicant
By a two-day written notice and physical termination of service by the City
By proper assumption of responsibility by another party and submission of a new application

The applicant warrants that all the information provided is true and correct and understands that false or misleading information shall be cause for the City to deny or cancel service and demand immediate payment of any amounts which are due.

I hereby make application to the City utility department for service and guarantee payment in accordance with the rates and regulations in effect at the time of delivery. I understand that if I default on these policies, I agree to pay reasonable expenses of collection including collection agency fees (currently 30% of the amount owed), attorney’s fees, court costs, and document preparation costs. The City of Santa Clara reserves the right to discontinue electricity, water, sewer, and/or garbage service if the applicant is one month or more in arrears, after proper notice in writing or in person.
Clear Signature
All applicants are required to deposit $200 and pay a $50 application fee.
Price: $50.00
Application Fee
$0.00