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2. 
3. City of Tavares Residential Utility Account Application

   201 East Main Street, Tavares, FL 32778 
   Telephone (352) 742-6400 Fax (352) 742-4590
   Email: utilitybilling@Tavares.org 

5. Service Start Date*
   Service Start Date
7. First Name*
8. Last Name*
10. Secondary Account Holder First Name
11. Secondary Account Holder Last Name
13. Service Address*
15. Mailing Address if different
17. City
18. State
19. Zip
21. Phone Number*
22. E-Mail Address
24. Cell Phone
28. Do you Rent, Own or Manage Property?*

    1. Rent
    2. Own
    3. Manage
29. Does this address have a separate irrigation meter?*

    1. Yes
    2. No
30. Would you like to receive delinquent payment reminders?

    1. Email
    2. Phone Call
    3. Text Message
34. Primary Account Holder Driver's License Number*
35. Secondary Account Holder Driver's License Number
37. Place of Employment
38. Occupation
42. A deposit of $175.00 is required upon opening a residential account. An additional deposit of $100.00 is required for each additional meter. There is a one-time service charge of $25.00 per meter for establishing a new account; this charge will appear on your first bill.
44. READ THIS SECTION CAREFULLY BEFORE YOU SIGN THE APPLICATION BELOW

    The undersigned customer hereby applies for connection of utility services to that premises for residential use at the scheduled rates, until and unless notice is given to the City in writing that service is to be discontinued, for whatever period of time.  The undersigned customer agrees to conform to all ordinances, rates, rules and regulations of the City of Tavares utility service as are now or hereafter in force and which are made part of this contract.  The customer also agrees to pay the wastewater capital charge, the water capital charge and the connection fees as provided for in these ordinances.  The customer further agrees that all charges for utility services, as they may become due from time to time, shall be and are hereby made a lien upon the above property so long as said charges remain unpaid, as between parties to the contract. (Section 17-4, City of Tavares Land Development Regulations)  Any customer’s previous outstanding balances will be transferred to the customer’s new account. Each party agrees that the electronic signatures on this document, whether digital or encrypted, are intended to authenticate this application and to have the same force and effect as manual signatures.

46. Signature*
47. Date
    Date
49. Secondary Applicant Signature
50. Date
    Date
54. Upload Copy of Primary Applicant Identification*
56. Upload Copy of Secondary Applicant Identification
58. Upload copy of lease, welcome letter, or management agreement
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field