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1
2Farm Hill Utilities, Inc.
120 Madrid Rd.
P.O. Box 61 Cantonment, FL 32533
Phone: (850) 968-2573
Fax: (850) 937-0930
Account Number: ________________
Date: ___________
Name: _________________________
Rent: ____ Own: ____
Service Address: _________________
Standard
3/4
Meter
_______________________________
Meter Fee:
$10.00
Mailing Address: (If Different)
Membership:
$15.00
_______________________________
Backflow:
_______________________________
Impact Fee:
DL#:___________________________
Road Bore:
Home Phone: ____________________
(If Needed)
Cell Phone: ______________________
Deposit:
$200.00
New Meter: NO
TOTAL FEE:
$225.00
This is to certify that the above meter deposit has been made with Farm Hill Utilities, Inc.
The deposit amount is security for the payment of or to be applied to any and all amounts
due upon cancellation of service. The deposit is the only amount that is refundable.
st
th
1. The net amount of the bill shall be collected between the 1
and the 10
of each month.
th
The gross amount of the bill is due after the 10
.
Failure to receive bills or notices shall not
prevent such bills from becoming delinquent nor relieve consumer from payment of bill.
If statement is not received, call (850) 968-2573 between the hours of 8:30a.m. and 4:00p.T
st
2. The water will be disconnected if payment is not made by 8:00a.m. on the 21
of each
month. The customer will be charged a reconnect fee of
$30.00
and the water disconnected
if payment is not received by the disconnect date.
3. If the meter is turned back on after it has been disconnected by a Farm Hill employee for
non-payment a
$50.00
tampering fee will be charged to the customer on the first offense, and
the meter completely removed on the second and the customer may be denied water service.
4. Meter box and valve will be unobstructed and accessible to the meter reader at all times.
A bush or tree may not hang over a meter box unless it clears the box by at least 6 feet.
fences will need an off-set built around the box or gate within 3 feet of. No customer will
allow a connection extension to be made to their service line for the purpose of supplying
water to another user.
5. If a customer requests their meter to be re-read and the reading is found correct there will be
a
$5.00
charge added to the bill. If the reading is incorrect the bill will be adjusted
accordingly and no charge will be assessed.
6. Minimum monthly charges and penalties will accrue if Farm Hill Utilities is not notified to
make the account inactive due to moving off the system, extended vacations, or any form of
interruption of service.
STATISTICAL INFORMATION
Ethnicity
Race
Hispanic or Latino ____
American Indian/Alaska Native ____
Not Hispanic or Latino____
Asian ____
Black/ African American ____
Native Hawaiian/ Other Pacific Islander ____
White/ Caucasian ____
Gender
Male ____ Female____
I do not wish to furnish this information ____
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