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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. Purpose of Application:*

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

  6. Rates

  7. Set-up Fee

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

  8. 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 reconnection fee of $50.00 will be assessed. Payment in full of all outstanding charges, including the reconnection fee will be required before services can be restored. I agree to be responsible for any damage to the water meter and any other damage pertaining to the service connection. 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.

  9. 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.

  10. FOR OFFICE USE ONLY

  11. Previous Owner

    __________________________________

  12. Account #

    __________________________________

  13. New Account #

    __________________________________

  14. Meter Reading

    __________________________________

  15. Capture 2

  16. Date Cans Ordered

    __________________________________

  17. Date Setup

    __________________________________

  18. Leave This Blank:

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