Commercial Business Application

Commercial Business Application

For Utility Services
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.
- A $500.00 deposit will be added to the first bill.
- 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 or provide it to us by phone at 801-789-6609. 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
Application Status*

ApprovedDenied
Reason for Denial

Business Information
Business Name*
Tax ID*
Eagle Mountain Business License #*

Responsible Party/Owner Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Relation to Business*
Social Security/Tax EIN #*
Driver's License #*
State*
Expiration Date*

MonthDayYear
Date
Service 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
Number of Units
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
2nd Phone Number
Please enter a valid phone number.

Service Details
Services Requested*

WaterSewer
Requested Service Date*

MonthDayYear
*Please note: it can take up to 3 business days to process request.
Number of Garbage Cans to be Serviced:*
Number of Recycle Cans to be Serviced:
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.
Please attach a copy of a valid ID. *

Cancelof
Deposits can be applied to accounts after a one-year record of on time payments per your request.

Agreement for Utility Services
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 a 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 or 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:

Commercial Business Application

OFFICE USE ONLY

Business Information

Responsible Party/Owner Information

Service Details

Agreement for Utility Services