Application For Utility Service Form - City Of Dover Utility Department
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1C i t y
o f
D o v e r
A p p l i c a t i o n f o r U t i l i t y S e r v i c e
Name_________________________________________
Soc. Security Number _____-____-______
Employer _____________________________________
Bus. Telephone Number _______________
Driver’s License Number ________________________
Date of Birth _________________________
Applicant’s Home Telephone Number _____________________________
Spouse’s Name_________________________________
Soc. Security Number ______-____-______
Spouse’s Employer______________________________
Applicant’s Previous Address _________________________________________________________
New Service Location ____________________________________
Beginning (date) ___________
Please Check All That Apply:
Own ___
Rent ___
Whole House ___
Apartment ___
Mobile Home ___ Garage Only ___
Landlord or Previous Property Owner ____________________________________________________
Is This A:
Residence ___________
Business ___________
Services For Which You’re Applying:
Electricity ___
Water/Sewer ____
Trash Removal ____
The Structure Has
Electric Heat _____
Gas Heat ____
Have you or your spouse previously held an account with Dover Utilities? Yes___ No___
If “Yes,” Address ____________________________________________________________________
If “No,” Please list Most Recent Electric Service Provider_____________________________________
Remarks:___________________________________________________________________________
I hereby apply for Utility Service(s) for the above address, and agree to abide by the rules and
regulations of the City Of Dover Utility Departments both current and future. I further certify that, to the
best of my knowledge, I have no outstanding balance owed on a previous City of Dover Utility Account.
WARNING:
Making false statements in application for utility service is a misdemeanor or may be a felony in some instances.
WE PROSECUTE. If you or a spouse have an unpaid final bill for another address within the City of Dover, the
balance must be paid in full before this application will be processed. Application in the name of a minor (under
age 18) is prohibited.
Signature __________________________________________________ Date ____________________
Office Use Only:
Account Number Assigned ___________________ Account Type (Rate Code)___________________
Effective Date _________________
Deposit Amount $_________
or Letter of Credit _________
Date Deposit or Letter of Credit Received ___________
Clerk _______________________________
Date Account Closed _______________
Reason _______________________________________
Applic1.doc 6/29/98
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Parent category: Legal