Water Contract, Crab Orchard Utility

Crab Orchard Utility

Water Contract

2089 E 1st St. Crossville, TN 38555

Telephone 931-484-6987, Fax 931-484-2970

It is the policy of the UTILITY to require that the applicant seeking service be the responsible party residing at the service address. Anyone seeking service who is acting on the applicant's behalf may be required by the UTILITY to provide the applicant's written verification as well as applicant's identification papers, as required below.

Whenever an application is made for service and the UTILITY has knowledge of a dispute as to the ownership of the right of occupancy at the service address, and one or more of the claimants attempts to prevent such service being furnished, the UTILITY reserves the right to adopt either one of the following two courses:

Treat the applicant in actual possession of the premises at the service address as being entitled to such service, notwithstanding the rights or claims of other persons;
Withhold service pending a judicial or other settlement of the rights of the various claimants.

THIS AGREEMENT, entered into by and between CRAB ORCHARD UTILITY DISTRICT, of Cumberland County, Tennessee, A UTILITY, established and existing under the laws of the State of Tennessee, hereinafter referred to as the "UTILITY". and the applicant hereinafter referred to as "CUSTOMER".

Full Legal Name *

Spouse Legal Name

Street/911 Address (for service) *

City *

State *

Zip *

Billing Address (if different)

City

State

Zip

Phone Number of Service Address *

Phone Number of Billing Address (if different)

Email *

Spouse Email

Driver License Number *

Spouse DLN

Social Security Number *

Spouse Social Security Number

Birth Date

Spouse Birth Date

Employer

Spouse Employer

Employer Address

Spouse Employer Address

Employer Phone

Spouse Employer Phone

Work/Day Phone

Spouse Work/Day Phone

Emergency Contact Name of Relative NOT at Service Address *

Emergency Contact Address

City

State

Zip

Emergency Contact Phone *

Emergency Contact Email

All applicants requesting the installation of a new tap or activation of an existing tap, not previously activated, for the non-refundable sum of $50.00 or $75.00, shall be required to pay the Utility's monthly minimum. Failure to pay said monthly bill shall result in the meter being de-activated.

By signing, I have read and accepted a copy of the Crab Orchard Utility Water Contract.

Signature *

Date

Print Name *

Effective Date