Residential Utility Service Agreement Form

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All fields with an asterisk * are required.

SERVICE INFORMATION

Service Address: *

If you need your water service restored today additional fees may be charged. Please call the Utility Billing office at 503-570-1610. Otherwise your service will be restored no earlier than next business day.

Effective Date: *

Month

Day

Year

First Day of Ownership or Lease Date.

Effective Date Comments:

If needed, please describe any additional information about the effective date.

APPLICANT

Applicant Type: *

Owner

Renter

Realtor

Other

Other:

Is this home vacant and pending a Renter or Sale? *

Yes

Applicant Name: *

Co-Applicant (if applicable):

Mailing Address: (used for future invoices) *

City: *

State: *

Zip: *

Primary Phone Number: *

Secondary Phone Number:

Applicant Email Address: *

Have you had a prior account with the City of Wilsonville? *

Yes

What is the prior address? *

OWNER

Owner or Management Company: *

Mailing Street Address: *

City: *

State: *

Zip: *

Phone Number: *

Email Address:

AGREEMENT TO COMPLY WITH TERMS OF SERVICE

The Applicant hereby contracts with the City of Wilsonville to provide utility services to the above service location. Applicant agrees to comply with all applicable city codes and regulations, including without limitations Wilsonville Code Chapter 3 & 4. In the event Applicant files for bankruptcy, but wishes continued service, Applicant agrees that a new account may be created for such services. Any billing dispute needs to be addressed within 90 days. Applicant understands failure to pay for service in full may result in penalties, termination of service, additional fees, a property lien, and/or reporting to various credit bureaus. Furthermore the applicant agrees to notify the Utility Billing Department in writing at least two business days prior to discontinuation of service; otherwise he/she will be held responsible for charges until the date the department is notified in writing.

Signature: *

Date Signed:

Electronic signature agreement. By selecting the "I Accept" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement.

I Accept: *

Yes

UTILITY BILLING

Phone: 503-570-1610
Email: utility@ci.wilsonville.or.us
Fax: 503-682-1015

Public Works:
503-682-4092
Emergency/After Hours:
503-682-1231

City Hall - 2nd Floor
29799 SW Town Center Loop E
Wilsonville, OR 97070
Get Directions

Monday - Friday
8:00am - 5:00pm

Mailing Address:
29799 SW Town Center Loop E
Wilsonville, OR 97070

Residential Utility Service Agreement Form

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