Utility Service Agreement Form
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2Morgan City Account #_________________________________________
(Office use)
UTILITY SERVICE AGREEMENT
Morgan City Corporation
90 West Young Street, P.O. Box 1085
Morgan, Utah 84050-1085
Fax Number: (801)-829-6684
(80l) 829-3461
APPLICANT NAME
: _______________________________________________________ Date: ___________________________
(PRINT)
SERVICE/PROPERTY ADDRESS
: ____________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
(IF DIFFERENT)
Soc Sec #: _______________________________________________ Phone: ______________________________________
Email Address: _________________________________________________________ DOB: ________________________
Employer: ________________________________________________________Phone#____________________________
Previous Address: __________________________________________________________________
__________
Name & Address of Nearest Relative; ________________________________________________________________
(Not at same address)
CO- APPLICANT and/or SPOUSE
: ______________________________________ Phone # ___________________________
Employer: ________________________________________________________Phone # ___________________________
EFFECTIVE DATE TO START SERVICE
***
: ________
_________________________________***
Power
Water
Sewer
Garbage
SELECT SERVICE REQUIRED:
new
The Set-up fee for a
garbage utility account: $65.00
Garbage fee collected?
Yes
No
CHECK THE BOX THAT APPLIES TO APPLICANTS(s)
OWNER
TENANT
LEASING
If Renting, Please provide the property Owner/Landlord Name ______________________________________________
A DEPOSIT IS REQUIRED FOR ALL RENTAL PROPERTY APPLICANTS. THIS DEPOSIT IS FULLY
REFUNDABLE AND MAY BE APPLIED TO THE FINAL BILL AND/OR REFUNDED TO THE APPLICANT
UPON TERMINATION; IF A FORWARDING ADDRESS IS PROVIDED UPON TERMINATION.
DEPOSIT:
Date Deposit Paid _______________
Amount Paid _______________
Receipt No _______________
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Parent category: Business