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City of Farmington Electric Utility System Residential Utility Service Application Please check all utilities applied for: ($30 connect/transfer fee per meter on the first bill) Date: Electric Water Sewer Sanitation Other Adults Residing at Service Location Name: Social Security No. Date of Birth: Previous Address: Name: Social Security No. Date of Birth: Previous Address: If you are a Landlord and this service is for a tenant, please check here. If you are a tenant, please check here and attach lease. ____Other SERVICE ADDRESS: Begin Service Date: (Next business day minimum) I have read and understand the attached COF/FEUS General Information and by checking this box and submitting this application, I am hereby authorizing the City of Farmington to check my credit history. I agree that if any unpaid or written off utility account(s) are found to be have been owed by me, my Spouse, or any other adult residing at the residence to the City of Farmington, I must immediately pay the account(s) balance or written off amount, plus an increased deposit equal to the greater of $100 or the highest historical bill in the last 12 months X2 for the location, or service will be refused. Signature Date Please submit form to FEUS – 101 N. Browning Parkway, Farmington, NM 87401 Email: [EMAIL REDACTED] or Fax to (505) 599-1477 FOR OFFICIAL USE ONLY Applicant Information Spouse Information (if applicable) Name: Name: Driver’s License (state & number) or Individual Taxpayer Identification No. (ITIN) Driver’s License (state & number) or Individual Taxpayer Identification No. (ITIN) Social Security Date of Birth: Social Security Date of Birth: Cell Number: Work/Home Number: Cell Number: Work/Home Number: Employer: Occupation: Employer: Occupation: Mailing Address (if different than service address): Email Address: Emergency Contact Information – REQUIRED (NOT LIVING WITH YOU) Name: Relation: Address: Phone Number: Deposit Amount (Electric) Deposit Amount (Water) Customer ID# Location ID# CSA: Date: ---PAGE BREAK--- FEUS/COF Utility General Information • Timing of Utility Bills o Due date of bills 14 days from billing date o Late fee assessed 25 days from billing date on unpaid bills o First Disconnect notice mailed with next month's bill if previous bill remains unpaid o Second Disconnect mailed 5 business days prior to disconnect o Service terminated approximately 30 days from due date of unpaid bill • Bill Payment o Payment Options : cash, check, money order, credit or debit card o Payment Methods ■ Walk-In/Drive-up Window/ Drop Box: 101 N. Browning Parkway ■ Online: http://www.farmingtonnm.gov ■ Mail: City of Farmington P O Box 209569 Dallas, TX 75320-9569 ■ Telephone: [PHONE REDACTED] or ■ Automatic bank withdrawal - sign up at either office City of Farmington 101 N. Browning Parkway Farmington, NM 87401 o Budget Billing is available to customers current in payments for utility services o Disputed/erroneous bills ■ Undisputed portions of the bill must be paid ■ Adjustments to bill will not exceed 1 year • Deposit Policy o All new accounts and accounts with no or poor credit history will be assessed a deposit o All deposits are location specific and equal a 2 month average bill for your location o Deposits are held for a minimum of 12 months o Usage parameter changes may result in deposit adjustments • Access to Premises o By accepting service, customer grants access to premises for utility purposes to properly identified FEUS personnel o For non-payment disconnect, emergencies or power restoration, access may be gained by cutting locks on gates or, in extreme cases, damage to customer's gate o FEUS staff needing to perform maintenance work will attempt to contact utility customer with tag at gate and telephone calls. No response by customer after 30 days to FEUS contact attempts, may result in a re occurring, non-refundable fee assessed on customer's utility account • Customer's Responsibility for FEUS/COF property o All equipment furnished by the utility remains the property of the utility o Customer shall exercise proper care to protect utility property and to prevent the theft of, damage to, tampering or interference with such equipment o Customer must notify FEUS/COF within 2 working days to apply for service upon taking possession of premise where utility service is on o Turning on utility service or continuing to use existing service without notifying FEUS/COF will result in liability to customer for all charges of utility service rendered and may result in meter tampering charges, civil penalties, additional fines and possible incarceration Planning on a change to your existing electrical requirements? Examples or this Include adding rerrigerated air conditioning, a hot tub and changing to electric appliances. It is imperative to contact Electric New Service at [PHONE REDACTED] for a transformer check/ Failure to give FEUS advance notice of load changes may damage FEUS equipment and inte"upt customer's service. Equipment repair/replacement cost may, at the option of FEUS, be charged to the customer.