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Application/Permit for Service

Effective Date:

Name:

Email:

Phone 1:

Phone 2:

Service Address:

Billing Address Information:

Layout:

Drivers License:

State Issued:

Social Security Number or FEIN:

I agree to notify Gulf Shores Utilities in advance of any change in the nature or characteristics of service from that stated above and to pay any additional applicable fees in effect at that time.

If for any reason service is not available to the described property, all fees will be returned and permit becomes null and void.

I understand that this application, if for water service, is for potable water service only and that Gulf Shores Utilities does not make any representations regarding the availability or adequacy of flows and pressures for the purposes of fire fighting.

If this application includes sewer service, the separate forms entitled “Additional Sewer Requirements” and “Agreement for Sewer Service Via Pressure System”, as applicable, are hereby made part of this application. I, the Applicant, certify that the above information is true and correct and that I have read and understand the conditions of service, and agree to the terms and conditions as set forth in the “Handbook of Rates, Charges and Procedures”, including any amendments as authorized by Board Resolution.

By submitting this application you authorize Gulf Shores Utilities to process this application and verify all information provided.

OFFICE USE ONLY

Deposit Due (Not Interest Bearing):

Re-establishment Fees Due:

Installation Fees Due:

Other:

Total Amount Due:

Paid This Date:

Authorized By:

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Your legal name

Your email address

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Signed by Nikki Lawley
Signed On: December 24, 2023

Timestamp

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October 9, 2023 12:43 pm CDT

Application/Permit for Service Uploaded by Nikki Lawley - gsucsr2@gmail.com IP 99.194.186.160