Rebate Application

Rebate Application

Government
Complete this application and return it to City Hall or submit via email to info@cityoflarchwood.org. Please include a copy of your receipt.
Larchwood Rebate Application 

    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: