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2. 
4. New Service Information Form
6. Customer Name*
8. Social Security/Tax Number*

   Please provide only the last four digits and call the office to give remaining social security number (704) 734-4594.

9. Email Address*

11. The social security number will be used to facilitate collection of utilities if you do not timely and voluntarily pay the bills.  Using the social security number will allow the City of Kings Mountain to claim payment of an unpaid utility bill from any state income tax refund that might otherwise be owed to you.   Your social security number may be shared with the state only for this purpose.  

13. Service Address*

    Location that you are requesting services.

15. Mailing Address

    Only required if different from the service address.

17. City
18. State
19. Zip Code
21. Phone Number*
22. Cell Phone Number*
24. Place of Employment*
25. Work Phone Number*
27. Emergency Contact Name*
28. Emergency Contact Phone Number*

30. AUTHORIZED USER:  The authorized user is able to call and retrieve information on the account such as the balance, account number, etc.  Without an authorized user the only person that is able to get this information on the account is the account holder.

32. Name of Authorized User
33. Social Security Number of Authorized User

    Please provide only the last four digits and call the office to give remaining social security number (704) 734-4594.

35. Relationship
36. Phone Number
38. SERVICES REQUESTED (ALL SERVICES WILL BE CONNECTED UNLESS OTHERWISE NOTED) THE CITY OF KINGS MOUNTAIN ACCEPTS NO RESPONSIBILITY BEYOND THE METER
40. Date that you want services connected*
42. Gas Service
43. Water Service
44. Electric Service

46. City of Kings Mountain Utility Service Agreement

     

     

    The utility bill will be processed and mailed by the 5^th business day of each month and will be due by the 20^th of each month.   Utility accounts with a balance of $10.00 or more after 5:00pm on the 20^th of the month will accrue a late fee of 1% of the balance due with a minimum of $10.00.  Receipt of payment on utility accounts is due on the last business day of the month by 5:00pm to avoid disconnection of services and a processing fee of $50.00.  Once the service(s) is (are) disconnected, the bill must be paid in full for reconnection.   To induce the City to accept this application and provide utilities to the customer, the customer agrees to comply with the City’s rules and regulations and to promptly pay for all utilities received.

     

    When you’ve paid on your utility account for 12 consecutive months without incurring a late fee your deposit will be credited back to your account.  (Not applicable to businesses)

     

    When you move, you will need to come into the office with a valid picture ID to close the utility account.

     

    On your first bill you will be charged a $15.00 service fees for each service you have.  (Electric, gas or water).  These fees are a one-time charge and are non-refundable.

     (Ex:  So if you have electric and water your will be charged $30.00)

     

    *Bank Draft is available upon request.  Utility accounts are drafted each month on the 20^th.   Please let your service representative know if you are interested.

     

    *If you have gas service, it is the customer’s responsibility to have the landlord/homeowner call the gas department (704-734-4516) to set an appointment to have the lock taken off the meter and turned on. The electricity must be on at the property prior to making an appointment. The gas department will only meet the homeowner or a licensed heating contractor to have this done. Appointments made up to 2:00 pm on scheduled work days.

     

    * It is the property owner and/or tenant’s responsibility to insure that all plumbing fixtures including commodes, sinks, dish washers, and hot water heaters are in good working order and that all valves, faucets, and spigots are closed so not to flood their property or have used a large volume water when the water is turned on.

     

    Landfill Charges will be charge per container at service location.  It is the responsibility of the customer to contact the Public Works Department, (704)734-0735 for any billing questions, changes, and/or container requests.   Every customer is billed storm water monthly.  

48. Documents needed for service

    You are required to submit the following documents with the service information sheet:

    A copy of the lease agreement or proof of ownership.

    A copy of a state issued id/driver's license.

50. Deposit Requirement/Service Fees

    A service fee of $15 per metered service will be billed on your first utility bill.

    A deposit may be required up front before service is connected.  In lieu of deposit you may submit a current twelve (12) month payment history, with no late fees, from a previous utility provider.

52. Signature*

    Typing your full name here indicates that you have read and agree to the Utility Service Agreement and will serve as your authorized signature. 

53. Date*
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

* indicates a required field