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CS_utility Request Form FI

This document is a utility services request form for the City of Swift Current, detailing the process for connecting, disconnecting, or transferring utility services. It outlines the requirements for pre-authorization payment plans and utility deposits, as well as the need for consumer acknowledgment of service terms. Contact information for customer service is provided for further inquiries.

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yogesh11.reddyv
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© © All Rights Reserved
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2 views

CS_utility Request Form FI

This document is a utility services request form for the City of Swift Current, detailing the process for connecting, disconnecting, or transferring utility services. It outlines the requirements for pre-authorization payment plans and utility deposits, as well as the need for consumer acknowledgment of service terms. Contact information for customer service is provided for further inquiries.

Uploaded by

yogesh11.reddyv
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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UTILITY SERVICES REQUEST

NAME
MAILING ADDRESS
PHONE CELL EMAIL
CO-OCCUPANT
MAILING ADDRESS
PHONE CELL EMAIL
DOB MONTH DAY YEAR DRIVERS LICENSE
SERVICE REQUEST (PLEASE CHECK ONE)
CONNECT DISCONNECT TRANSFER OTHER
CONNECTING TO: REQUESTED DATE:
DISCONNECTING FROM: REQUESTED DATE:
Please note: We do not backdate connects or disconnects and do not do same day or weekend service so please date accordingly.
PRE-AUTHORIZATION PAYMENT PLAN YES NO CONTINUE CHANGE
UTILITY DEPOSIT TO BE PAID PRIOR TO CONNECTION
Please provide a banking debit authorization from bank or void cheque for any new, continuing and changes to payment plan

FOR OFFICE USE:


EXISTING ACCOUNT FOR DISCONNECTION FROM NEW ACCOUNT TO CONNECT TOO
ACCOUNT NUMBER ACCOUNT NUMBER
PREMISE NUMBER PREMISE NUMBER
WATER METER NUMBER WATER METER NUMBER
WATER METER READ WATER METER READ
DATE OF DISCONNECTION DATE OF CONNECTION
ELECTRIC METER NUMBER ELECTRIC METER NUMBER
DATE OF DISCONNECTION DATE OF CONNECTION
ELECTRIC METER READ ELECTRIC METER READ
SOCK YES NO PULL METER YES NO
GARBAGE CART # GARBAGE CART #
COMPLETED BY CYCLE #
DIRECTIONS

AS A CONSUMER OF CITY OF SWIFT CURRENT UTILITY SERVICES, I UNDERSTAND:


1. SERVICE TECHNICIANS MUST BE PERMITTED ENTRY ONTO MY/OUR PROPERTY TO READ METERS AND/OR PERFORM OTHER
DUTIES RELATED TO UTILITY SERVICES.
2. IF MY/OUR UTILITY ACCOUNT IS OUTSTANDING AFTER TWO MONTHS OF BILLING, SERVICE MAY BE TERMINATED AT ANY TIME, IN
ACCORDANCE WITH THE NOTICE ON MY/OUR UTILITY BILL.
3. TRANSFER FEE MAY BE APPLICABLE FOR ANY TRANSFER OF SERVICES FROM ONE ACCOUNT TO ANOTHER
4. UTILITY DEPOSIT REQUIRED FOR ALL NEW SERVICE CONNECTIONS
OCCUPANT SIGNATURE: DATE:

CO-OCCUPANTSIGNATURE: DATE:
FOR FURTHER INFORMATION PLEASE CONTACT OUR
CUSTOMER SERVICE DEPARTMENT AT (306)778-2731 / FAX (306) 778-2194
OR EMAIL AT [email protected]
Notice to Utility Account Holders
Utility Deposit:

You will need to make a utility deposit before the utility connection is made. This can
be paid with cash, cheque or debit. If you are unable to make it down to city hall during
our working hours of 7:45 am to 4:30 pm, and you want to pay by cash or cheque you
can deposit it in a sealed envelope in our night deposit box on the side of City Hall.

Questions:

If you have any questions, please feel free to contact the customer services
representative at 306-778-2731 or by email at [email protected]

General:

• If connecting/disconnecting a business, please attach a copy of a business card


for the contact person.

• Utilities can be provided at two addresses for up to 5 business days


without an additional deposit being required.

• If you have an outstanding bill at a previous address this will need to be paid
before a connection can be established.

• We do not backdate connections or disconnections and do not do same day


or weekend services so please date accordingly.

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