Contract

ACKNOWLEDGEMENT OF TERMS AND CONDITIONS: *

BILLS ARE PAYABLE IN OUR OFFICE WITH CHECK, DEBIT/CREDIT CARD OR MONEY ORDER.

IF YOU WISH TO PAY WITH CASH, YOUR BILL CAN BE PAID AT BUILTWELL BANK.

UTILITY BILLS ARE A RECURRING CHARGE.

IN THE EVENT OF NOT RECEIVING A BILL, THIS DOES NOT RELIEVE YOU OF YOUR RESPONSIBLITY TO PAY.

PLEASE CONTACT OUR OFFICE AT (931) 762-9481 TO INQUIRE ABOUT THE AMOUNT YOU OWE.

IF YOU FAIL TO PAY YOUR BILL AND YOUR WATER IS DISCONNECTED FOR NON-PAYMENT, A $50.00 RECONNECT FEE WILL BE ADDED TO THE TOTAL OF YOUR BILL.

ALL FEES ARE NON-REFUNDABLE.

WATER DISCONNECTED FOR NON-PAYMENT WILL ONLY BE TURNED BACK ON DURING REGULAR BUSINESS HOURS.

IF WATER IS DISCONNECTED FOR NON-PAYMENT, A PAYMENT IN FULL MUST BE RECEIVED IN OUR OFFICE NO LATER THAN 2:00 PM FOR THE WATER TO BE RECONNECTED THE SAME DAY. ALL PAYMENTS AFTER 2:00 PM WILL BE RECONNECTED THE FOLLOWING BUSINESS DAY.

I HAVE READ THE CONTRACT AND AGREE WITH THE TERMS AND CONDITIONS. SUBMIT FORM AND CLICK ON NEW SERVICE PAYMENT BUTTON TO MAKE YOUR PAYMENT.

HOUSEHOLD OCCUPANTS : *

ADDRESS OF PROPERTY : *

PHONE: *

NAME: *

FEES: **PLEASE NOTE THAT YOU WILL ONLY USE THE OWNER TRANSFER FEE IF YOU OWN THE PROPERTY AND DO NOT INTEND TO LIVE THERE (FOR RENTAL PURPOSES ONLY). IF YOU PLAN ON LIVING AT THE RESIDENCE, THE $50.00 CONNECTION FEE WILL APPLY. *

DATE AND TIME *

BILLING ADDRESS (IF DIFFERENT) :

NORTHEAST UTILITY DISTRICT 1054 MATTOXTOWN RD.LAWRENCEBURG, TN 38464 PHONE: (931) 762-9481

ALTERNATE PHONE NUMBER: