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2. 
4. Transfer Service Request Form
6. Current Service Information
8. Customer Name*
9. Social Security Number*

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

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. Email Address*
14. Date to be disconnected*
16. Service address - moving from*
18. New Service Information
20. Service address - moving to*
21. Date to be connected*
23. Mailing Address

    If different than service address.

25. City
26. State
27. Zip Code
29. Phone Number*
30. Cell Phone Number*
32. Emergency Contact Name*
33. Emergency Contact Phone Number*

35. 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.

37. Name of Authorized User
38. Social Security of Authorized User

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

40. Relationship
41. Phone Number
43. ALL SERVICE WILL BE CONNECTED UNLESS OTHERWISE NOTED. THE CITY OF KINGS MOUNTAIN ACCEPTS NO RESPONSIBILITY BEYOND THE METER

45. City of Kings Mountain Utility Service Agreement

     

     

    The utility bill will go out on the last 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 each month by 5:00pm to avoid disconnection of services and a processing fee.  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)

     

    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)

     

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

     

    *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 gas department will only meet the homeowner or a licensed heating contractor to have this done. 

     

     

    Landfill Charges will be charged for each container at the 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 recycle and storm water monthly.  

47. Documents needed for service

    Your 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.

49. Deposit Requirements/Service Fees

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

    A deposit/additional deposit may be required if you have additional services or have accrued late charges on your current account.

    
    

51. 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.

52. Date*
Leave This Blank:


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

    This field is not part of the form submission.

56. Submit Submit and Print

* indicates a required field