MCINTOSH, AL 36553-0092 PHONE (251)944-2083 FAX (251)944-8814

MCINTOSH WATER AND FIRE PROTECTION AUTHORITY
MCINTOSH, AL 36553-0092 PHONE (251)944-2083 FAX (251)944-8814
APPLICATION FOR NEW METER SERVICE PAYMENT PLAN
DATE

MonthDayYear
Date
NAME OF APPLICANT
ADDRESS
LOCATION
THE UNDERSIGNED HEREBY APPLIES TO MCINTOSH WATER AND FIRE PROTECTION AUTHORITY FOR A TAP ON THEIR WATER MAIN. THE AFOREMENTIONED TAP WILL BE LOCATED ON THE PUBLIC ROAD RIGHT OF WAY. THE AUTHORITY SHALL INSTALL THE NECESSARY EQUIPMENT AND METER TO BE THE PROPERTY OF THE AUTHORITY, THE METER SHALL REMAIN OFF UNTIL SUCH TIME AS A SECURITY DEPOSIT AND TURN ON FEE IS PAID BY THE PERSON OR PERSONS ASSUMING THE RESPONSIBILITY OF THE BILL.

INSTALLMENTS: THE APPLICANT WILL PAY DOWN ON A NEW METER THE TOTAL OF $275.00, WITH 12 MONTHLY INSTALLMENTS OF $25.00.

PAYMENTS WILL BE INCLUDED ON MONTHLY BILL
APPLICANT SIGNATURE
**THIS IS FOR CUSTOMERS STARTING A NEW SERVICE THAT NEEDS TO SET
UP A PAYMENT PLAN FOR THE NEW METER. **
Should be Empty: