City of LaFayette
LaFayette, Georgia
Application for utilities for commercial or other
You must show proper identification.
Name of business __________________ Owner’s name _________________
Type of business ___________________ Social Security number __________
Business address ___________________ Partner’s name ________________
Mailing address ____________________ Business phone ________________
Home phone _________________
Utilities requested: Electricity _____ Water _____ Natural gas _____
Electric deposit amount to be determined by electric superintendent.
Have you had utilities with the city before? ____________
If yes, where and in what name? _______________________________________
Name of last business at this address ____________________________________
Zone ____________
_______________________________________________________________________
Please, read carefully.
I understand that my utility bill will be due on the _____ of each month and should be paid within 15 days and a late charge of 10 percent will be added after the due date. Service will be disconnected if not paid within 20 days from the date the bill is mailed. A connection fee will be charged before utilities will be turned back on. Utilities will be disconnected upon finding that the structure served has been or is being used for the manufacturing of any controlled substance, as provided by Sec. 21-27 et seq. Code of Ordinance.
Notice: A false statement in this application could result in disconnection of power!
I have received a copy of the underground gas piping maintenance form.
Date _______________ Customer’s signature ____________________________
_______________________________________________________________________
Deposit number _______ Date ________ Clerk's signature _______________
Bad debt shown _____ Amount due ______ Amount paid __________
Remarks ______________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Return to Administration.