Utility Application

Utility Application

Government
Complete this application for Utility Service

You can either download and complete the PDF form at your convenience or fill out and submit the form directly through our website, depending on your preference.

Larchwood Application for Utility Service

    Name:

    Account #

    Service address:

    PO Box #

    SSN#

    Phone Number #

    Renter?

    Work Phone #

    Other residents:

    Have you previously been a customer of Larchwood Municipal Utilities? If so please provide address:

    Garbage pickup is every Friday morning and Recycling is 1st & 3rd Thursdays. Utility bills are mailed our monthly, the first of every month. Payment is due by the 20th of each month unless the 20th falls on a Saturday, in which case, payment is due on Friday. If the 20th falls on a Sunday, the payment is due the next business day following the 20th. WE ARE NOT RESPONSIBLE FOR THE u.s. MAIL DELIVERY. FAILURE TO RECEIVE BILL DOES NOT EXCUSE PAYMENT.

    FEES: The following fees are subject to change:

    Returned Check Fee

    $30.00

    If two or more checks are dishonored within a six month period, the utility shall require future payments to be made by cash, cashier's check, postal money order or electronic transfer.

    Late Penalty Fee

    1 ½%

    Tag Fee (for delivery of disconnection notices)

    $25.00

    Reconnect electric service (Before 3:30 pm / After 3:30 pm)

    $25.00 / $50.00

    Reconnect water service (Before 3:30 pm / After 3:30 pm)

    $25.00 / $50.00

    ACKNOWLEDGEMENT TO UNDERSTANING OF DOCUMENT

    Customer Signature:

    Date: