APPLICATION FOR NEW WATER/SEWER/REFUSE SERVICE

All information requested is for billing purposes and will be kept confidential.

Date Service to Begin:  ____________________________________________________

Account Name:___________________________________________________________

Social Security Number:______________________________Date of Birth:___________

Service Address:__________________________________________________________

Billing Address:___________________________________________________________

(If different than service address)

Have you ever had Water/Sewer/Refuse Service with the Village of Forest?____________

If yes, we WILL NOT open new service if you have an outstanding bill at another address.

If so, when?__________________At what Address?______________________________

Do we need to cancel service at this address?_________  Date to end service:__________

A $110.00 deposit is required for all new services to rental and land contract properties.  This fee, along with the above information, is needed before service can begin at the proposed address and is kept in strict confidence.

The Village of Forest will send out monthly Water/Sewer/Refuse bills at the 1^st of each month.  Bills are due by the 10^th of each month.  Any bill received after the 10^th of the month will be accessed a late penalty, determined by the amount of usage.  Shutoff notices are sent out on the 20^th of each month.  Payments will be accepted up to 5:00 p.m. the day before the end of the month.  If your bill is not paid in full by that date, your water will be shut off on the final day of the month.  Water will not be turned back on until receipt of payment and/or the next business day. 

According to ordinance, all Forest residents will pay $11.50 per month for refuse service.

By signing, I am stating that I have read and understood the above terms and conditions of having utility service with the Village of Forest and that all above information is true and accurate.

______________________________________________________________Date:____________________

Applicant Signature

For Office Use Only:

Date Received:_______________Received By:__________________

Deposit Payment:_______________Cash or Check #:_____________