PLEASANT GROVE CITY APPLICATION FOR UTILITY SERVICE
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I am the legal owner
I am a renter (note if you clicked renter you do not need to fill this form out. Pleasant Grove city only allows the owners to have their names on the primary account.)
Type of property
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New Build
Existing
Closing Date
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Month
-
Day
Year
Date
Name
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First Name
Last Name
Email
example@example.com
Service Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address if different from Service address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
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Area Code
Phone Number
2nd Phone Number
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Area Code
Phone Number
Driver's License Number or EIN if you are a business
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I hereby apply for the following service(s)
Water
Sewer
Secondary
Recycling
Garbage
Number of Garbage cans on property
Number of Recycle cans on property
Number of Garbage cans to remove
Number of recycle cans to remove
Order garbage can
Order recycle can
I certify that I am the legal Owner/Resident
Landlord agreement needs to be filled out if renting/leasing the property.
Comments:
After sending back form kindly call with your sign-up fee.
801-785-5045
After sending back this form I agree to call with the fee payments mentioned above.
Please read before signing.
I hereby apply for the above services from Pleasant Grove City for the above named premises and agree to pay the applicable charges for said services in accordance with rate fixed by the City and regulations at time of delivery.
In the event of failure to pay for these services as provided by law, the City shall have the right to discontinue services at its election.
I agree to pay all reasonable attorney fees and other costs incurred by the City to recover payment.
I agree to pay all penalties and fees while any balance is outstanding on this account. Ex; 15.00 monthly late fee. 18% collection fee.
Signature
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Submit
Should be Empty: