Utility Application

Utility Application
Name on Account*

First NameLast Name
Type of Customer
Type of Service
Property Status*
Service Requested*
Turn on Date Requested*

MonthDayYear
Date
Email*
example@example.com
Would you like to receive E- Billing Statements?*

YesNo
As an e-billing customer, you will no longer receive a paper bill in the mail. Instead, you will receive a monthly electronic billing notification by e-mail. This e-mail notification will provide you with a link to view your bill on the City of Livingston’s secure website.

Please ensure your e-mail information is correct. If for any reason the electronic notification is undeliverable, the City of Livingston will attempt to contact the customer by phone. If unsuccessful, a letter will be mailed. If a correct e-mail address is not provided prior to the next billing cycle, traditional paper billing will resume.
Service Address*

Street Address

CityState

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Billing Address:*

Street Address

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Date
Drivers License Number blanks*
State of Drivers License blank*
- Applicant agrees to abide by all City Ordinances & Rules. Service is exclusively for the Applicant.
- Bills are due and payable by the 15th of every month. After the 15th, you will receive a 10% late charge.
- After the 25th of every month, you will receive a $50.00 reconnection fee.
- Service may be denied without notice for delinquency in payment or violation of law and/or City ordinances, rules or regulations.
- Applicant does hereby swear or affirm that all information supplied on this application is complete and accurate.
- The final bill is deducted from deposit and whatever if remaining from the deposit will be mailed to the customer.
- Household garbage (MUST BE IN A BAG) is picked up Monday, Wednesday, and Friday.
- Yard Debris ( No construction demolition ) is ppicked up on Tuesday and Thursday.
If the gas and water deposit is not paid online, the customer had 48 hours to come in to make the deposit before a disconnection of services.
Signature*

Clear

My Products
prevnext( X )
Water Deposit$200.00 Deposit $6.28 Stripe Fee - Website Card charges
$206.28 Quantity
Item subtotal:$0.00

Gas Deposit$200.00 Deposit $6.28 Stripe Fee- Website Card Charges
$206.28 Quantity
Item subtotal:$0.00

Total

$0.00
Should be Empty: