Police & Fire
Parks & Rec
UTILITY SERVICES APPLICATION/AGREEMENT
Filling out the following form will speed up your application process. However, you still
NEED TO PRESENT
a valid government issued ID ( driver's license or passport/tarjeta consular) in our office before a work order for your service is put in place. If you have any questions, please call customer service representatives at 801-229-7275.
*Requested Service Date
Thursday, March 23, 2017
Friday, March 24, 2017
Monday, March 27, 2017
Tuesday, March 28, 2017
Thursday, March 30, 2017
Friday, March 31, 2017
Monday, April 03, 2017
Tuesday, April 04, 2017
Thursday, April 06, 2017
Friday, April 07, 2017
Monday, April 10, 2017
Tuesday, April 11, 2017
Thursday, April 13, 2017
Friday, April 14, 2017
Monday, April 17, 2017
* Your complete application and the copy of your ID need to be in our office by 2 PM in order to receive
Spouse/Co-Signer Name [Optional]
I would like to receive paperless monthly bill statement notifications
No, I would like to receive monthly paper bill statement through the mail
*Applicant's ID Type
*Date of Birth
*Applicant's Prev. Address
Applicant Employer Name
Employer Phone #
Spouse Employer Name
Employer Phone #
Emergency Contact Information
* This page is not applicable for business account!
Please select the number of cans you want. However, the first garbage can is required per living unit.
1st Can ($10.65)
Additional Can (9.65)
Recycle Can ($3.20)
Green Waste Can ($5.70)
* Recycle is picked up every other week on your garbage day
* Green waste is Mar 1st. - Nov 30th every week on garbage day. You will only be billed the $5.70.
* Price is per can.
If you are a new resident to our city, you might want to know the following important phone #:
Rocky Mountain Power: 1-888-221-7070 | Questar Gas: 1-800-323-5517 | Qwest Telephone: 1-800-244-1111
Fees and Charges
Terms and Conditions
Water Base Rate – Varies according to property’s meter size
Water Usage – Monthly meter reads from March through October (March bill has 5 months winter water usage)
Sewer Base Rate
Sewer Charge – Set at City average for the first year
City Franchise Tax
Garbage Charge – Recycling and Green Waste services available at additional cost
Street Lighting – depending on property location
I/we, the undersigned, hereby apply for services with the City of Orem for the above premises and agree to pay a monthly fee for watersupplied which is due within 30 days of being invoiced. The rate, as well as other fees, charges and fines related to water service, is established by resolution of the City Council. Failure to receive a bill or an e-mail notification (for paperless billing) does not relieve customer of liability.
A NON-REFUNDABLE $15 LATE FEE is assessed to all accounts that are not paid IN FULL by the DUE DATE.
An account setup fee of $25.00 will be included in the first bill.
The account shall be subject to termination of services upon non-payment or failure to comply with rules, regulations, ordinances, or laws as established by the City.
Water service shall not be restored after being shut off until all money owed, including deposits, fines, fees, and penalties have been paid in full.
All bills sent to water users shall be deemed to be correct if they are not disputed within sixty (60) days from issuance.
There will be a charge on all returned checks in the maximum amount allowed by state law and customer agrees to pay the same.
By requesting services, the applicant agrees to keep current all payments and agrees to pay all costs of collections (not to exceed 40% of the bill), including reasonable attorney fees and interest if the account becomes delinquent.
Applicant here by warrants and affirms that the information provided in this form is true and correct to the best of his/her knowledge. Applicant also affirms, understands, and agrees to comply with provisions of this utility application for services.
Confidential Information (Passwords)
*SSN/Tax ID if a Business
*Re-Type SSN/Tax ID
*Acct. Access Password
*Re-Type Acct. Access Password
I am at least 18 years of age and I agree with the terms in the agreement.
Online Bill Pay
Orem Public Library
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56 North State Street • Orem • Utah, 84057 • Phone: 801.229.7000 • Fax: 801.229.7031 • Copyright © 2013 City of Orem •