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BUSINESS NAME*

Date*

LOCATION ADDRESS*

Street Address Address Line 2 City State ZIP Code

DATE TO START SERVICE*

IF TRANSFER, DATE TO STOP SERVICE

ADDRESS TRANSFERRING FROM

TRANSFER A/C #

Type of Business*

Other

Does the property have the following?

Irrigation System
Pool
Fire System w/Pump

Owner/Lessee*

FEIN*

Billing Address*

Street Address Address Line 2 City State ZIP Code

Local Contact*

Contact No*

Accounts Payable Contact

Contact No

A/P Email

Third Party Payment Center

Third Party Address

Third Party Contact

Contact No

Third Party Contact Email

Is property?*

Purchased (Warranty deed or settlement statement must be provided)
Leased (Lease must be provided)

Owner/Lessee Driver’s License No*

Owner/Lessee SSN*

Owner/Lessee Contact No 1

Owner/Lessee DOB*

Owner/Lessee Contact No 2

Untitled

YES, I WOULD LIKE TO BE ENROLLED IN TEXT NOTIFICATIONS.

Cell Number

Untitled

YES, I WOULD LIKE TO BE ENROLLED IN E-BILL.

E-mail

Untitled

YES, I WOULD LIKE TO BE ENROLLED IN BANK DRAFT. Please complete bank draft authorization form.

Untitled

YES, I HAVE PREVIOUSLY HAD SERVICE IN ALABASTER.

Address

The Account Holder(s) hereby request to be supplied with water by the undersigned Alabaster Water Board of the City of Alabaster, Alabama, for the purpose shown herein and none other. Account Holder(s) agree to pay for the service at regular scheduled rates applicable from time to time as set by the Alabaster Water Board now or at any future time and to comply with the rules and regulations of the Alabaster Water Board of the City of Alabaster, Alabama. Account Holder(s) further agree that:

1. The Alabaster Water Board shall retain title to all meters and other property. INITIAL:*

2. Account Holder(s) shall be responsible for the safekeeping of all property of the Water Board placed on premises. INITIAL:*

3. Account Holder(s) shall guarantee free right of ingress and egress by the Water Board employees to meters and other property of the Water Board located on the said premises without obstructions (i.e., shrubs, decks, porches, parked vehicles, restrained animals, fences, etc.). INITIAL:*

4. Account Holder(s) will keep in good repair all appliances and piping on said premises (other than meters maintained by the Water Board), first notifying the Water Board prior to having repairs made, and will report immediately to the Water Board any leaks discovered. INITIAL:*

5. Account Holder(s) shall not adjoin a supplementary water source (well, pool, etc.) to a new or existing water meter on the Alabaster Water Board's system. INITIAL:*

6. The Alabaster Water Board or the City of Alabaster shall not be liable for damages because of interruption of the supply of water by reason of fires, accidents or any other cause due to or alleged to be due to the installation of service, and Account Holder(s) agree to indemnify the Alabaster Water Board against liability, loss or damage by reason thereof; and Account Holder(s) further agree to notify the Alabaster Water Board in writing one week (7 days) prior to vacating said premises or discontinuance of service for any reason. INITIAL:*

7. The Alabaster Water Board shall not refund any payments made by the Account Holder(s), for service pipe from the property line to the meter, unless covered by separate agreement. INITIAL:*

8. A late penalty of 10% of the current water, sewer, and garbage fees will be added on the delinquent date printed on the utility bill. INITIAL:*

9. A deposit may be required before service is provided. The deposit will be applied to any unpaid charges when service is terminated and any remaining balance greater than $5.00 will be returned to the customer of record. Deposit refunds less than $5.00 will only be processed upon customer request. Uncashed or unclaimed deposits after one year will be the property of the Alabaster Water Board. Deposits will not earn interest. INITIAL:*

10. If Account Holder is a new construction builder and the property fails inspection, the Account Holder may be billed for any charges incurred. INITIAL:*

11. A non-refundable application fee will be charged. INITIAL:*

12. Discontinuance of service will be as follows:

a. Any amount past due in excess of $25.00 shall be subject to being cut-off/disconnected. INITIAL:*

b. Cut offs and reconnections will be performed Monday through Friday during business hours of each week and reconnections only on Saturday between the hours of 10:00 am and 2:00 pm. INITIAL:*

c. A delinquent processing fee will be charged. INITIAL:*

d. The account must be paid in full plus the processing fee before service will be reinstated. INITIAL:*

e. If for any reason a reconnection occurs after hours, there will be an additional call out fee. INITIAL:*

f. If financial assistance is needed, Account Holder(s) will notify Alabaster Water prior to disconnection of service to request a payment arrangement or financial assistance through a 3rd party. INITIAL:*

13. The undersigned hereby agrees to be liable for, pay, or reimburse the Alabaster Water Board for all costs and expenses, including, but not limited to, reasonable attorney's fees. As such, the undersigned agrees to pay any/all additional fees incurred by the Alabaster Water Board in collecting or attempting to collect any sum due by the undersigned to the Alabaster Water Board for water and/or otherwise. Therefore, the undersigned is responsible for payment to the Alabaster Water Board for water and/or otherwise; and waives all rights for exemption as to personal property under the constitution and laws of the state of Alabama or any other state. Additionally, a percentage rate of 30% incurred by the Alabaster Water Board, or entities representing or working on behalf of Alabaster Water in collecting or attempting to collect any sum due, will be added. INITIAL:*

14. The Alabaster Water Board shall have the right to discontinue service without further notice in case of the Account Holder(s) failure to comply with this agreement or any part thereof, and the Account Holder(s) agree that any unpaid balance(s) on established account for services rendered, will be paid promptly at time service is discontinued. INITIAL:*

I understand

I understand that the property referenced may be subject to the Board approved Alabaster Water Board Backflow Prevention and Cross-Connection Control Policy. The policy, which can be viewed at www.alabasterwater.com, requires customers who could potentially discharge hazardous materials into the water system to install a testable backflow prevention device and submit annual testing results to the Board. Failure to comply with the policy will result in penalties and/or disconnection of water service.

CITY OF ALABASTER ORDINANCE 24-212 REQUIRING THE REPAIR OF WATER LEAKS WITHIN THE CITY OF ALABASTER, ALABAMA The Account Holder has received a copy of the Adopted City of Alabaster Ordinance and understands that failure to comply with the Adopted Ordinance can result in disconnection of service. INITIAL:

SPECIAL INSTRUCTIONS

Signature 1:

Date

Signature 2:

Date

Below is old data

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