NEW SERVICE

Name:___________________________________________________

Service Address:___________________________________________

Billing Address:____________________________________________

SSN or Driver's License Number:______________________________

Phone Number:____________________________________________         Are you over 18 years old?  Yes  No

Have you resided in Bowling Green before? (including rural B.G.)  Yes  No

Date Service to Begin:________________________________________

Owner's Name and Address:___________________________________________________________________

I understand that I am responsible to pay a water deposit of $160.00 before my services can be started.  As a renter, I do not receive my deposit back until I no longer require water service from the City of Bowling Green .  As an owner, I will receive my deposit back after two years of having an account in good standing.

I understand that I am responsible for any billing that is incurred from the date service begins until the date that I contact the water department at City Hall to discontinue services.  I also understand that the bills are due the 10th of each month.  If I do not have my bill paid in full at this time I will be charged a 5% penalty, at which time my bill is delinquent and will be given until 5:00 p.m. on the 20th of that same month to pay the balance in full.  I understand that if my payment is not received BEFORE 8:00 a.m. on the 21st, that I am subject to a $35.00 penalty and services shall be disconnected until my balance has been paid. (Please note there is a night deposit box located on the side of the building beside the door.) I also understand that should my services be disconnected, I will not try to turn the water on myself or have anyone else turn the water on for me.  If this should occur charges will be filed with the Police Department for tampering with City property and stealing water.

I also understand that should I write a check for payment prior to the 20th and the check is returned for nonpayment, I will be given 5 business days to come in and pay for the check and a $15.00 returned check fee with cash or a money order.  If the check is written on the 20th or 21st the water shall be immediately disconnected and not restored until the balance is paid in full.  If at any time 2 returned checks are received within a 12-month period, check writing privileges will be suspended for a one-year period.  It is understood that the City does not accept out-of-state or two-party checks.

I also understand that if I am a renter and should my bill  become delinquent, a notice will be sent to me and to my landowner.

Signature:___________________________________  Date:_____________