Application For Service - Fort Valley Utility Commission

APPLICATION FOR SERVICE
Applicant Information
New Service or Transfer Service ?*

NewTransfer
Check services desired:*

ElectricWaterGasTelecom
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
SS #*
Driver's Licence #*
Email*
example@example.com

Authorized Person
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
SS #
Driver's Licence #
Phone Number
Email
example@example.com
This Authorized Agent has authorization to speak or make changes on my behalf regarding my utility bill..

Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Connect Date*

MonthDayYear
Date
If transfer, current address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Disconnect Date

MonthDayYear
Date
Billing address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How do you want to receive your statement(bill)?*

E-BillPaper BillBoth

I would like to opt out of monthly courtesy bill notification calls.