Residential Utilities Business & Collections Services MenuBusiness & Collection Services Customer Service Enhancements Business Services Survey Energy Share Program Customer Service Residential Utilities Form Instructions:Complete all pertinent fields, then read the information below the form.First Name *Middle Name *Last Name *Customer Phone Number *Date of Birth *Last four digits of SSN *To turn-on Utility Services, please complete Section A and Deposit Requirements. You may attach picture ID and lease or you can fax or email picture ID and lease (fax: 252-972-1521 or email: customerservice@rockymountnc.gov)SECTION ADate to turn on ServicesService AddressCityStateZIP CodeDo you:RentOwnLandlordLandlord's PhoneRealtor/Lawyer's PhoneHome PhoneSpouse's NameWork PhonePrevious AddressCityStateZIP CodeI would like to enroll in the Load Management Program.To disconnect Utility Service, please complete Section B:SECTION BLocation to turn OFF servicesDate to turn OFF servicesDate to turn ON servicesLocation to turn ON servicesHome PhoneSpouse's NameWork PhoneEmployerServices RequestedElectricGasWaterArea LightDeposit RequirementsA 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: Letter of Credit from previous utility account from a utility company confirming a good pay history for the past 12 months. Co-signer who must have an active account with the City of Rocky Mount for at least 2 years with a Good Pay History. **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. By providing your social security number and phone number(s), this information shall be utilized for customer verification, debt collection attempts which are subject to credit reporting, or third party collections.YesNoEmail AddressSECTION C: Forwarding AddressHouse PhoneStreet AddressCityStateZIP CodeDateEmail AddressApplication 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 and to complete the application process. 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.Upload FileDrag and Drop (or) Choose Files SubmitPlease do not fill in this field. Business & Collection Services Payment Options Virtual Kiosk New Services Business Express Rates & Fees Utility Assistance Deposit Policy Customer Service Policy Energy Share