Residential Utilities

Customer Service Residential Utility Application

Instructions: Complete all pertinent fields, including Required* fields, then read the information at the bottom of the form. Click the Submit Form button to send the information; click Clear to start over.

REQUIRED INFORMATION:

First Name:
  
Middle Name:
  
Last Name:
  
Phone Number:

 

To turn-on Utility Services, please complete Section A and Deposit Requirements

SECTION A

Date to Turn On Services:
  
Service Address:
  
City:
  
State:
  
Zip Code:
  
Do you:Rent    Own

 

Landlord: Realtor/Lawyer (to verify ownership):
     
Landlord's Phone: Realtor/Lawyer's Phone:
     
Home Phone: Driver's License Number/State:
     
Work Phone:  Spouse's Name:
     
Employer:   

 

SECTION B

Location to Turn Off Services: Date to Turn Off Services:
     
Location to Turn On Services: Date to Turn On Services:
     
Home Phone:  Please update the following:
     
Work Phone:  Driver's License Number/State:
     
Employer: Spouse's Name:

 

Deposit Requirements

A utility deposit may be required for new or transferring customers. Deposits are credit-based and range from $0 to $325. The primary credit source will be your City of Rocky Mount utility payment history. Utility deposit options are:

  1. Letter of Credit from previous utility account from a utility company confirming a good pay history for the past 12 months.
  2. Co-signer who must have an active account with the City of Rocky Mount for at least 2 years with a Good Pay History.
  3. **Equifax credit check to obtain credit rating to determine deposit requirement

** I give the City of Rocky Mount my permission to obtain my credit rating from a credit service to determine my deposit requirement for the above address.

Yes No                  Email address:

 

To disconnect Utility Services, please complete Section C:

SECTION C

Location to Turn Off Services:  Date to Turn Off Services:
     
 Forwarding Address:   
     
House Number: Street Name:
     
City: State:
     
Zip Code:   
     
Email: Date:

 

Application must be received in the City of Rocky Mount Utility Business Office 3 business days prior to connection/disconnection request. A Customer Service Representative will contact you to confirm receipt of your application.

Please contact our office if you have not received confirmation within 48 hours prior to your request, or if you have any questions. Our office hours are 8:30 a.m. to 5:00 p.m. Monday through Friday. Our telephone representatives are available at (252) 972-1250 from 8:30 a.m. to 7:00 p.m. Monday through Thursday and 8:30 a.m. to 5:00 p.m. on Friday.

For more information, or assistance with this form call 252-972-1250.



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