Utility Account Application/Change Form

City of Zephyrhills
Utility Account Application/Change Form

The under signed, as owner, agent, resident, or occupant of hereby applies for water, sanitary sewer, and/or solid waste services to said premises and agrees to  pay for said services at the  rates specified  by the City of Zephyrhills Code of Ordinances,

The undersigned further agrees to comply with and be bound by all rules, regulations, and ordinances of the City of Zephyrhills pertaining to  water, sewer, and/or solid waste services and  specifically agrees to pay all applicable charges.

New Account:                           _____    RESIDENTIAL                  _____  COMMERCIAL 

Name _____________________________________________________________________________________

Doing Business As  _____________________________________________________________________________________ 

Service Address _______________________________________________________________________________________

Mailing Address (if different)  ____________________________________________________________________________                                       

Phone Number  ______________________________                              

E Mail Address (optional)  ____________________________________________________ For E-Bills

Date to Connect Service ___________________________

Dumpster ________________________________________________________________                                

Note: Copy of rental agreement or lease must be shown if applicant does !lot own the property,

The City of Zephyrhills recognizes that an individual's driver's license number is a unique form of identification that can be utilized to obtain sensitive information regarding that particular individual. However, the City of Zephyrhills must collect Drivers License numbers under certain circumstances in order for the City to be able to properly perform its duties and functions as a municipal corporation and in order to ensure that such duties and functions are performed accurately and efficiently.

THE CITY OF ZEPHYRHILLS COLLECTS YOUR DRIVERS LICENSE NUMBER ONLY FOR THE FOLLOWING PURPOSES:

      CLASSIFICATION OF ACCOUNTS IDENTIFICATION
      CREDIT WORTHINESS OR COLLECTIONS BILLING AND PAYMENTS
      DATA COLLECTION, RECONCILIATION AND TRACKING
      NEW UTILITY ACCOUNT APPLICATION
      POLICE STATEMENTS AND ARRESTS FOR THE VERIFICATION OF IDENTITY

Each individual who provides a Drivers License number to the City of Zephyrhills shall be provided with a copy of this notice.

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