Application:
Please Print
|
Today's
date:_____________________________ |
Name:________________________________________________________________________________ |
Social
Security Number________________________________ |
Spouse's
name________________________________________________________________________ |
Social
Security Number________________________________ |
Address for service
connection____________________________________________________________
City:
___________________________
Phone number__________________________________ |
| Former
address______________________________________________________ |
Circle
desired services |
Electric |
Cable TV |
Internet |
Water/Sewer |
|
| Contract |
|
I agree to pay all
charges and to abide by all terms and conditions associated with utility
services as set forth in the City of Norway charter and code of
ordinances. I further agree to hold the City harmless for damages
resulting from utility service or from termination of service. The City
shall not be responsible for damages resulting from acts of nature,
termination of service for non-payment, service interruptions, system
malfunctions or conditions beyond the control of the City.
I further agree
- to allow City access to meters and service connections during normal
business hours and at any other time by appointment
- to provide meter placement in such a manner as to allow unobstructed
access by City personnel
- to notify the City Utility Office if billings are not received or if
billings are inaccurate.
This agreement does not in any way nullify the provisions found in the
City Charter or Code of Ordinances>
I have read this agreement and agree to abide by all terms and
conditions contained herein. |
|
Signature:___________________________________________________________ |
| Print
and return
to: City of Norway, PO Box 99, Norway
MI 49870 |
|
|
| Office
use only |
|
Received in
office:_____________________________________________________
|
| |