Re-Establishing Service Request

Customer Care
2791 East Point Street
East Point, GA 30344

Office: (404) 270-7010 | | Fax: (404) 559-4438
Email: customercare@eastpointcity.org
Website: www.eastpointcity.org

Re-Establishing Utility Services

I understand the following: (1) falsification of any information may result in immediate discontinuance of utility service without notice; (2) there will be a charge of $60.00 connection fee (3) failure to pay my utility accounts in accordance with the Customer Care Department’s policies will result in discontinuance of service; (4) failure to pay my final bill after any deposit refunds will result in the account being submitted to collections. I will, as a result, incur all collection costs.

First Name:*

Last Name:*

Name of Owner / Lessee:*

Service Address:*

City:*

State:*

Zip:*

Mailing Address:*

City:*

State:*

Zip:*

Contact Number:*

Email:*

Authorized Speaker:

Phone:

Customer's Signature:*

Date:*

MonthDayYear

Effective Date:*

MonthDayYear

Mailing Address:*

WAIVER OF LIABILITY TO RECONNECT ELECTRIC AND WATER SERVICE

RELEASE AND WAIVER OF LIABILITY: Property Owner/Lessee/Occupant hereby RELEASES, WAIVES and DISCHARGES the City of East Point Utilities, its successors and assigns, and its officers, employees, agents and consultants, from all liability, loss, claims, damages, possible or actual causes of action, cost, attorneys’ fees, and other expenses arising from any actions, claims, arbitrations, demands or lawsuits that may otherwise accrue, including claims for or relating to damages, loss or injury to persons or property, in any way resulting from or related to the connection of the Utility services to this property, from any cause whatsoever.

By signing below, I am stating that I have read this agreement and understand the possible ramifications of allowing Utility services connection without a responsible party on the premises and that I am the Owner/Lessee/Occupant of the property listed above:

Customer's Signature:*

Signature of Spouse or Other Occupant:*

Proof of Identification:*

Upload a File

(i.e. Driver's License, State Issued ID, etc.)

Date:*

MonthDayYear

Property Owner/Renter/Occupant*

(Full Name)

Service Address:*

Property Owner/Renter/Occupant Desires:*

ElectricWater

Property Owner/Renter/Occupant Name:*

Please Print

Telephone:*

Email:*

example@example.com

FOR OFFICIAL USE ONLY

Account #:

Flag RemovedStatus Changed

Electric Appointment Date:

MonthDayYear

Water Appointment Date:

MonthDayYear

Service Address:*