Commercial Application for Utility Service

COMMERCIAL APPLICATION FOR UTILITY SERVICE

Today’s Date *

Effective Date *

Business Name *

Business Address *

Business Address

City

State/Province

Zip/Postal

Country

Business Phone *

Applicant Name *

Applicant Phone *

Email *

Federal Tax ID Number *

ls applicant sole owner of this business? *

Yes

List the owners, or if Corporation or Partnership, Other Officers or General Partners

Mailing Address (if different from above)

City

State/Province

Zip/Postal

Country

Emergency Contact *

Emergency Phone *

Driver’s License Upload *

Maximum file size: 516MB

Driver’s License Number *

Consumer Responsibility

Please Read Full Consumer Responsibility

PAYMENT: The applicant agrees to pay monthly for the utility services rendered by the City of Santa Clara. Charges for services will be made at the regular established rate for the class of service applicable to applicant. DELINQUINCY: Payment for service is due immediately upon billing and shall become delinquent if not paid by the 20’h of the month. A penalty of 10% of the unpaid balance will be added to delinquent account. The applicant agrees to pay reasonable expenses of collection including attorney’s fees and court costs should it become necessary to use such measures to collect the charges. The City shall terminate services on delinquent accounts not paid after notice. ln order to restore service the customer must bring current all delinquent charges. ln addition, the City will charge a reconnection fee. SECURITY DEPOSIT: The applicant may be required to pay a deposit in order to receive service. lt is agreed by the applicant that the deposit is not considered as the payment of any bill. Unpaid accounts will be considered delinquent notwithstanding lhe existence of a security deposit. The City may apply the amount of the security deposit to the final ball of the customer, and any balance remaining will be refunded. REASONABLE ACCESS: The applicant shall permit the City’s authorized representative to enter on the customer’s premises at all times for purposes connected with rendering bill, or disconnecting utility services. TERMINATION OF SERVICES: The applicant agrees to be responsible for the payment of the utility charges incurred at these premises until their responsibility is terminated in one of the following ways: 1. By mutual agreement evidenced in writing and signed by the Caty and the applicant. 2. By a two day written notice to have servjces disconnected and the City physically terminating the service. 3. By the proper assumption of the payment responsibility by a party acceptable to the City and upon completion of an application for service by the other party. The applicant warrants that all the information provided by them in this application 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.

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Date Signed *

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