Application for Services – Santa Clara City

Residential Online Application for Utility Service

Residential Application for Utility Service

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Applicant Information

Click to fill out information. ***There is a $50.00 administrative fee and a $200.00

Landlord/Manager

Today's Date *

Effective Date *

Full Name *

Driver's License Number *

State Issued ID Card Upload: *

Maximum upload size: 134.22MB

Employer *

Spouse's Full Name

Spouse's Employer

Service Address *

Service Address

City

State/Province

Zip/Postal

Country

Mailing Address (If different than above)

City

State/Province

Zip/Postal

Country

Home Phone

Cell Phone *

Email *

References & Emergency Contact

Click to fill out information. Please list two relatives not living with you, and one person to be notified in case of emergency.

Name of Reference #1 *

Address of Reference #1 *

Reference #1 Phone

Name of Reference #2 *

Address of Reference #2 *

Reference #2 Phone *

Emergency Contact Name *

Emergency Contact Address *

Emergency Contact Phone *

Consumer Responsibility Agreement

Please Read Full 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. In order to restore service, the customer must bring current all delinquent charges. In addition, the City will charge a reconnection fee. Security Deposit: The applicant is required to pay a deposit. It is agreed by the applicant that the deposit is not considered as the prepayment of any bill. Unpaid accounts will be considered delinquent notwithstanding the existence of a security deposit. The City may apply the amount of the security deposit to the final bill of the customer and any balance remaining will be refunded to the customer. Reasonable Access: The applicant shall permit the city's authorized representatives to enter on the customer's premises at all reasonable times for purposes connected with rendering, billing or disconnecting utility services. Termination of Services: The applicant agrees to be responsible for the payment of 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 City and the applicant. 2. By a two day written notice to have services 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 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. I hereby make application to the City utility department for service and guarantee payment for said service in accordance with rates and regulations in effect at time of delivery. I understand that in the event of default of the above policies, I agree to pay reasonable expenses of collection including all costs of collection agencies, (currently 30% of the amount owed), attorney's fees, court costs and costs of preparing documents for court should it become necessary to use such measures to collect the charges made to the applicant's account. The City of Santa Clara reserves the right to discontinue electricity, water, sewer, and/or garbage service if applicant is in arrears one month or more, after proper notice in writing or in person. Santa Clara City provides power and water. The City also bills sewer and garbage services. Anyone needing utility services must fill out an application for service. A deposit of $200.00 and an administration fee of $50.00 is assessed with each application. This deposit will be refunded when the service is terminated and the bill is paid in full or it will be applied to the final bill. The utility offices are open from 8:00 A.M. to 5:00 P.M. Monday through Thursday. The office is located at Town Hall, 2603 Santa Clara Drive in Santa Clara. The telephone number is (435) 673-6712.

Signature *

Clear

I have read and agree to the Consumer Responsibility.

Download the Residential Application for Utility Services. Fill it out and bring it in with a State Issued ID Card to the Utilities Office at the Santa Clara Town Hall, located at 2603 Santa Clara Drive.

***There is a $50.00 administrative fee and a $200.00 deposit required.

Santa Clara City provides power and water. The City also bills sewer and garbage services. Anyone needing utility services must fill out an application for service. A deposit of $200.00 and an administration fee of $50.00 is assessed with each application. This deposit will be refunded when the service is terminated and the bill is paid in full or it will be applied to the final bill.