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NOTE: If an unpaid previous balance appears on the bill, the unpaid amount is NOT extended to the current month's due date.
NOTE: If a special trip is made to the customer's premises (special reads, re-reads, customer requested meter tests), a trip charge of $30.00 will be applied to the monthly billing.
NOTE: You may also download a PDF version of this document here: New Account Application.pdf. A PDF reader such as Foxit PDF Reader or Adobe Acrobat Reader is required to view or print this file.
COLLECTIONS (Ordinance 21-2004): The City shall be entitled to recover all costs, including but not limited to reasonable attorney's fees and/or collection service charges, incurred in collecting delinquent utility fees and charges.
LIEN FOR DELINQUENCY: As promulgated in detail in the City of Cocoa Code of Ordinances, all utility rates, fees and charges assessed shall be lien upon the property with which such rates, fees and charges are associated.
IMPORTANT INFORMATION: The City of Cocoa is not responsible or liable for loss or damage to any person or property whatsoever, resulting directly or indirectly from flooding beyond the water meter. It is the customer’s responsibility to make sure all water inside the dwelling is turned off to avoid flooding. If a Field Service Representative cannot turn the water on due to water running, the customer must contact Customer Service office to reschedule for a later time/date.
I hereby request and authorize the City of Cocoa Utilities to supply water and/or sewer services to the above described property, as well as all other services which may be attached to the property. I also agree to pay for said services at the rate established by the City of Cocoa and other Utilities which we bill and abide by the rules and regulations applicable to said service as outlined in the Utility Handbook.
IF YOU ARE UNABLE TO COME INTO THE OFFICE TO SIGN AND COMPLETE THIS FORM, YOU MUST HAVE THIS FORM NOTARIZED AND SUBMITTED TO CUSTOMER SERVICE ALONG WITH A LEGIBLE COPY OF YOUR DRIVER'S LICENSE AND SOCIAL SECURITY CARD.
STATE OF ______________________________
COUNTY OF ______________________________
Subscribed and sworn to (or affirmed) before me / personally known to me this _____day of_________20___
Produced _____________________________________________________ (Type of identification)
___________________________________________________________________ Notary Public.
____________________________________________________________________________ (Name of Notary typed, printed or stamped)
Application must be filled out in its entirety