Dear Prospective Customer:
To apply for service with the City of Ocala Utility Services, please visit our Customer Service Office located at 201 SE 3rd Street, Ocala, Florida. Our office hours are 8:00 a.m. to 5:00 p.m., Monday through Friday, except Holidays. If you prefer to apply by fax, please complete the attached
application (it must be notarized) and fax to (352)629-1381, Attn: Service Applications. You may also mail your notarized application to the address listed on the bottom of this letter.
Please make sure the following information is on the application or attached to the application when submitted:
• Complete physical address
• Proof of residency, i.e. lease, rental agreement, or proof of ownership • Effective date of service. New installations require more time.
• Billing Address (if different than physical address) • Daytime telephone number
• Social Security number • Copy of Drivers License • Signature
The residential deposit requirement is 2.25 times the average monthly bill or $250.00, whichever is greater. The deposit will be held on the account until the account is closed. A credit check will be conducted on all new customers. We accept cash, check, money order, Visa, MasterCard, Discover and American Express. If payment is made by credit or debit card, there will be a convenience fee of $4.95 charged by a third party vendor for each $400.00 increment. A service charge of $45.00 is due upon application for service. Same day service can be applied for in person up to 12:00 p.m. After 12:00 p.m., service will be processed for the next business day.
If you have further questions, please contact us at 629-CITY (2489). Sincerely,
Customer Service
Rev 10.09.15 CONTRACT FOR RESIDENTIAL UTILITY AND BILLED SERVICES
CUSTOMER SERVICE OFFICE
201 SE 3RD ST., OCALA, FLORIDA 34471-2174
Phone: (352) 629-CITY (2489) Fax: (352) 629-1381 Automated Customer Service Line: (352) 629-8216
Date ____________ Social Security No._____________________
The Customer Service Office collects your social security number for the following purposes: classification of accounts; customer identification and verification; customer billing and payment; creditworthiness; and other lawful purposes necessary in the conduct of City of Ocala business. The Customer Service Office may also release your SSN to other commercial entities engaged in the performance of commercial activities as permitted by law, i.e. collection agencies.
This contract for residential utility and billed services is subject to the terms and conditions imposed on such services by the City of Ocala, as the same may be amended from time to time
Service Requested in the Name of ___________________________________________ (Applicant) Requested By _________________________________ Applicant is the: Owner _____Tenant _____ Driver’s License # ________________________________ Email Address______________________ Service Address: __________________________________________________________________ Contact Numbers: Home ____________ Fax ___________ Office ___________ Cell ____________ Mailing Address (if different from Service Address): _______________________________________ __ I hereby consent to receive autodialed and/or pre-recorded calls from, or on behalf of, the City of Ocala Utility
Services at the telephone number provided by me. I understand that consent is not a condition of obtaining utility service. Initial connection charge is $45.00 and is due at start of service. Returning customers are charged $25.00. Same day service can be applied for in person up to 12:00pm.
Photo copies of identification and proof of occupancy must be on file with the Utility prior to the start of services.
DEPOSIT AGREEMENT (APPLICABLE TO ALL UTILITY AND BILLED SERVICES) Account No. ________________________ Deposit Amount $ ______________ Service in the Name of __________________________________________________
Service Address___________________________________________________ D O B ___________ E-Check Bank Routing Number __________________ Bank Account Number _________________
OR
Credit Card Number _________________________ Expiration Date ____/____ 3 Digit Code _____ The undersigned customer hereby grants the City of Ocala Utility Services ("Utility") a security interest in the service deposit provided for under this agreement to secure payment and performance of all
the debts and obligations arising from the provision of utility and other billed services (water, sewer, electric, storm water, solid waste disposal, yard lights, and/or fire services) to the customer in the ordinary course of business. The Utility shall keep possession of the deposit and will refund the deposit, or the remaining balance, only after such service has been terminated and the final bill charged for services rendered has been paid by the customer. The customer's deposit will first be applied to any outstanding balances owed, if any, before being refunded to the customer.
The above customer and the Utility have duly entered into this agreement on ____/____/____. ______________________________________ _____________________________________ Customer Signature OUS Representative
Notary required if not completed at OUS Offices:
DD
DEPOSIT VALIDATION
STATE OF ____________________COUNTY OF ______________________
The foregoing instrument was acknowledged before me this _______ day of ______,_____ by ______________________________,_______ who is personally known to me
Or who has produced _______________________________ as identification.
Rev 10.09.15
A copy of applicant’s Driver’s License is required with this application. Please copy
in the space provided below:
FAX both pages of this completed form to
Customer Service Center at 352-629-1381
Copy of Driver’s License
Copy of Social Security Card
CITY OF OCALA
COLLECTION OF SOCIAL SECURITY NUMBERS
THE __UTILITY SERVICES_________ DEPARTMENT OF THE CITY OF OCALA IS REQUESTING DISCLOSURE OF YOUR SOCIAL SECURITY NUMBER. SUCH DISCLOSURE IS (check one) __X___ MANDATORY (pursuant to Section __119.071_________; and/or necessary for the performance of the department’s prescribed duties and responsibilities); or, ______ VOLUNTARY.
COLLECTION OF YOUR SOCIAL SECURITY NUMBER IS FOR THE FOLLOWING PURPOSE(S) (check all that apply):
_____ CLASSIFICATION OF ACCOUNTS; __X__ IDENTIFICATION AND VERIFICATION; _____ CREDIT WORTHINESS;
_____ BILLING AND PAYMENT; _____ DATA COLLECTION;
_____ RECONCILIATION, TRACKING, BENEFIT PROCESSING; and,
