APPLICATION FOR UTILITY SERVICES

~PLEASE PRINT LEGIBLY. NOTICE: APPLICANT MUST SHOW PHOTO ID OR OTHER FORM OF PHOTO IDENTIFICATION~

Applicant Information

Name

Phone Number

Email Address

Physical Address ~ Street ~ City ~ State ~ Zip Code

Mailing Address

Employer

Employer's Phone Number

Employer's Address

Service

Service Start Date

Circle Services Needed

WATER

SEWER

note: all residential properties within village limits are required to pay the village for trash and water repair/improvement fees

Do you Own or Rent

Own

Rent

If Renting, Name and Phone Number of Landlord

Have you ever had a utilities account with the Village of Sugar Grove?

Yes

If yes, what address?

IN CONSIDERATION OF RECEIVING VILLAGE UTILITY SERVICES, YOU, THE SIGNER, AGREE TO THE FOLLOWING:

1. All utility bills are due and payable by the 15th of each month. Alleged failure to receive a utility bill will not constitute an excuse for nonpayment. No reduction in late fees or penalty will be made unless the customer can demonstrate, to the satisfaction of the Village, that failing to receive the bill was at the fault of the Village.
2. Nonpayment of bills, when due, may result in disconnection of service. The Village of Sugar Grove has the right to discontinue utility services or refuse to furnish the same for nonpayment for any utility bill owed, fraudulent or illegal diversions of services, and for any other reasons allowable by rules and regulations set forth in the Ordinances of the Village of Sugar Grove.
3. That in the case where I am purchasing property, an unpaid bill created by the former owner must be paid in full before the utilities will be transferred, and that certain charges, if not paid, can and will be certified to the Fairfield County Auditor for addition to the property tax, which I will have to pay.
4. That if I, my spouse, my tenant, or any other member of my household owes the Village of Sugar Grove any past due, delinquent bills of any type, they must be paid in full before any service will be provided. If such service is provided, and it is found out that such bills do exist, service may be disconnected at once, and until the bill has been paid in full.

I, the undersigned, hereby apply for utility service(s) for the above listed service address, and agree to abide by the rules of the Village of Sugar Grove's Utility Ordinance(s), and fee schedule that is available for review upon request. I further certify that, to the best of my knowledge, I have no outstanding balance owed for previous services with the Village of Sugar Grove.

WARNING ~ MAKING FALSE STATEMENTS ON THIS APPLICATION FOR UTILITY SERVICES MAY BE PUNISHABLE BY LAW

Signature

Applicant's Printed Name

Date

Applicant's SignatureType your full name to sign, or sign the printed copy.

For Office Use Only

Date Application Received

Village Employee Reviewing Application

Date Approved/Denied

Photo ID Provided/Copied

Date Service Begins

Date Service Ends

Village Account Number

revised: 6.27.24/sbh

Submit via Email opens your email program with your answers filled in. A signed form, photo ID, attachments or payment still need to be delivered as the form says.