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Application for Utility Services (Water & Garbage)

  1. Bluffdale City Utilities Application (Water & Garbage)

  2. (Must be Home Owner)

  3. (Must be Home Owner)

  4. Rental

    Check here if this is a rental and you want the tenant to get a copy of the bill.

  5. Purpose of Application:*

  6. Include proof of Purchase - Closing Statement from the closing documents with name, address & date of closing. NO Real Estate contracts or deeds.

  7. Rates

  8. Set-up Fee

    A set-up fee of $35 will be added to your first billing.

  9. License Information & Fee

    I, the undersigned, hereby apply for utility services from Bluffdale City for the above named premises and agree to pay any and all charges incurred for said services (including but not limited to culinary water, storm water, street lights and garbage collection) in accordance with rates fixed by Bluffdale City. Failure to pay my bill in full by the 25th of each month or having an excessive or extended balance, will result in an interruption or disconnection of service(s). I recognize and consent that a re-connection fee of $50.00 will be assessed. Payment in full of all outstanding charges, including the re-connection fee will be required before services can be restored. Damage By Customer: All damages or injury to the lines, meters or other materials of the city on or near the customer's premises caused by any act or neglect of the customer shall in the discretion of the city be repaired by and at the expense of the customer, and the customer shall pay all costs and expenses, including reasonable attorney fees, which may arise or accrue to the city through its efforts to repair the damage to the lines, meters or to other equipment of the department, or collect such costs from the customer. (Ord. 5-27-80-1, 5-27-1980, eff. 5-28-1980) Failure to pay said charges will result in interruption of services. I agree to pay all reasonable attorney fees and other costs incurred by Bluffdale City to obtain collection on this account, whether or not litigation is actually filed.

  10. Electronic Signature*

    By checking 'I Agree', you agree to acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.

  11. FOR OFFICE USE ONLY

  12. Previous Owner

    __________________________________

  13. Account #

    __________________________________

  14. New Account #

    __________________________________

  15. Meter Reading

    __________________________________

  16. Capture 2

  17. Date Cans Ordered

    __________________________________

  18. Date Setup

    __________________________________

  19. Leave This Blank:

  20. This field is not part of the form submission.