Application for Utilities

Are you a Co-Signer? Select the circle below and then the "Next" Button at the bottom of the page to go to Co-Signer Signature. Once you have signed, continue through the form until the end and press "Submit".

Co-Signer Applicant
Property Ownership Pre-Screening
Do you Own or Rent this Property?*
Do you intend to rent this property to someone else?*
Is this Property Managed by another party (individual, property management company, etc.)?*

YesNo
Name of Property Manager or Property Management Company*
Property Manager Phone Number*
Please enter a valid phone number.
Property Manager Email*
example@example.com
Do you authorize the property manager to make changes to the utility account on your behalf?*

YesNo
Property Manager Mailing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
OPTIONAL: Select who should receive a copy of the monthly billing statement in addition to the property owner

TenantOther
Per change to City code 13.20.050, utility accounts must now be in the name of the property owner. PLEASE INFORM YOUR LANDLORD AND DO NOT COMPLETE THIS FORM. If you have any questions, please email utilitybilling@emcity.org or call 801-789-6609.
Application for Utilities
General Guidelines
- A valid photo ID is required on the form. Please upload a copy when prompted and attach it to the application.
- Please note it can take up to three business days to process your submission.
- If you have had a previous account with Eagle Mountain City and are starting services at a new address, please note that your account number will change and you will need to update your online bill pay with the new account number.
- There is a required $40 deposit that will be billed on your first statement. Deposits can be refunded to accounts after a one-year record of on time payments per your request.
- $25 reconnect fee applies if the water service is currently turned off. This fee is billed on the first statement.
- Fields with marked with a red asterisk (*) must be completed.
Important*

All information provided as part of this form will be stored by a third-party service provider. If you do not wish to provide personal information such as your SSN or ID# on the JotForms site, we require that you provide them in person at the Utility Billing office. To view details regarding the security measures put in place by JotForms, please visit: https://www.jotform.com/security/
OFFICE USE ONLY
Click Next to go to OFFICE USE ONLY fields

OFFICE USE ONLY

Changes will be saved automatically
Reviewed By (Name or Initials)*
Reviewed Date:*

MonthDayYear
Date
This Property is a Rental
Application Status*

ApprovedDenied
Reason for Denial

PPROPERTY OWNER INFORMATION
Your Name*

First NameLast Name/Business Name
Date of Birth or Date Business Incorporated

MonthDayYear
Date
Social Security/Tax EIN #*
Driver's License # or Business License #*
State*
Enter the State that issued your driver's license or if a business then enter the State that the business is registered in.
Expiration Date*

MonthDayYear
Enter the date your Drivers License/Business License Expires
Service Address (New Eagle Mountain Address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your mailing address the same as the service address?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Prior Account with Eagle Mountain City?*

YesNo
Account Number or Address*
Your Email*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.

Service Details
Service Start Date*

MonthDayYear
Start day needs to be at least 1 business day in the future. Please note it can take up to three business days to process your request.
Additional Comments
If you have any comments regarding your requested services, please share here.
By signing this form, you agree Eagle Mountain City can transfer any balances you may owe from previous Eagle Mountain City utility accounts to your current account.
Would you like a Co-Signer on this Application?

YesNo
Co-Signer Name*

First NameLast Name
Co-Signer Email*
example@example.com
Co-Signer Phone
Please enter a valid phone number.
Co-Signer Signature

Clear
Co-signer will be sent an email requested they sign
Co-Signer Social Security Number *
Co-Signer Driver's License Number*
Co-Signer Driver's License Issuing State*
Co-Signer Driver's License Expiration Date*

MonthDayYear
Date
Please attach a photo of the front of your driver's license. If your application includes a co-applicant, please take a photo of the front of both driver's licenses together. *

1 image limit. If you have trouble with this section, please contact utility billing at 801-789-6609
Cancelof

Agreement for Utility Services
The undersigned applicant hereby applies to Eagle Mountain City, a municipal corporation of the state of Utah (referred to as the City), for utility services from the City to the above lot number, in the above subdivision or to the property at the address listed above.

The undersigned applicant acknowledges that water, sewer, storm drain, garbage and recycling are provided and/or billed by the City when and where such services are or may be available at the date of this application or within a reasonable time in the future and that this Agreement of the applicant to connect to and use such utility services is required by the Ordinances of the City.

The Applicant agrees to pay all utility service charges and other related fees and charges to the City in full as they become due. The timely payment to the City of all required fees and charges is a condition for the continued service of all utilities to the property described above. The applicant hereby agrees to comply fully with all ordinances, rules and regulations in force at the date of this agreement or to be enacted in the future by the City for utility services.

This agreement is executed by the Applicant as property owner or by an authorized agent of the property owner. By accepting the services from utilities furnished by the City under this agreement, the property owner and Applicant agree to be bound by the terms of this Agreement.

I agree that late fees and/or interest in the amounts adopted by Eagle Mountain City will accrue on all past-due amounts until paid in full. In the event that any amounts are referred to a third party debt collection agency, I agree that in addition to any other amounts allowed for by law, such as interest, court costs, and reasonable attorney's fees, I will also be responsible for collection fees in the amounts owing as allowed by Utah Code Ann. § 12-1-11. The terms of this paragraph shall apply to all amounts incurred by myself of by any individual that has legal responsibility for this account whether such amounts are incurred today or after today.

I, the undersigned, hereby certify that the information given is true and correct.
Name*

First NameLast Name
Signature*

Clear
Today's Date
Should be Empty:

Property Ownership Pre-Screening

Application for Utilities

OFFICE USE ONLY

PPROPERTY OWNER INFORMATION

Service Details

Agreement for Utility Services