Online Application for New Utility Service
By submitting this application, Applicant acknowledges: 1. The above information is true and correct to the best of my knowledge
(City Code Section 20-1-11 states that it is unlawful for any person to obtain utility service by deceitful means or artful
practice which includes providing false information during the application process); 2. Applicant will pay all applicable
utility charges and fees for service at the above location, and any other debts owed to the City including court judgments
and fines shall be paid prior to obtaining utility services; 3. Penalties may be charged for late payment and service will
be discontinued for failure to pay all charges by the due date shown on monthly statements; 4. Residential sanitation charges
are mandatory within the City limits regardless of actual use of this service except for vacant rental property in an approved
Landlordís name; 5. The City may utilize my social security number and other information to determine my credit score and verify
employment for the purposes of determining my deposit and collecting unpaid amounts. Should I choose not to provide my social
security number, I understand that I will be charged the maximum deposit; 6. An unexpired picture ID issued by a State or the
Federal government is required for identification purposes; 7. Applicants with delinquent amounts owed to the City of any type
shall be subject to having utility services terminated for failure to pay said debts; 8. The City shall not be responsible
for the transmission or use of utility services beyond the Applicantís meters.
Please fax a copy of your lease or purchase agreement plus a picture ID to our Customer Service office at 706-883-2041 or email this information to firstname.lastname@example.org or mail to Customer Service at 200 Ridley Ave, LaGrange, GA 30240.