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Apply Online for Services

Name :
Service Address :
Mailing Address :
Phone Number :
Social Security Number :
Place of Employment :
Employer's Address :
Spouse or Co-Applicant :
Social Security Number :
Place of Employment :
Employer's Address :
Owner of Property :
Owner's Address :
Services :	Electric yes no Water yes no Sewer yes no Garbage yes no D/D Light yes no In City yes no TV Cable yes no Basic I Basic II HBO Showtime Cinemax Guide(s) yes no

Please read and understand the following text before submitting your application for any utility or service.

Subject to the rules and regulatins of the City of Phillipi, and which the applicant agrees, shall form part of this contract, application is hereby made for the above marked service(s), of which the applicant is renter or owner of said property, and in consideration of the delivery of aforesaid service, the applicant agrees to the following:

First: To pay for all services delivered to the premises at the published rates of the municipality and settle all bills therefore within twenty (20) days from the date of bill at the City Clerk's Office, excepting that all bills shall become due and payable forthwith in case of discontinuance of services.

Second: To pay for all services delivered to premises until such time the applicant notifies in writing the authorized contract agent of the municipality of an intention to remove from said premises, discontinue the use of services, or terminate in any manner the applicant's liability under this contract.

Third: All bills that remain unpaid for a period of twenty days after the same became due and payable, shall be delinquent and owner/user shall be held liable until such time as all charges are paid. All charges whenever delinquent shall be held liable until such time as all charges are paid. All charges whenever delinquent shall be filed for collection with the Magistrate Court System of West Virginia or shall be liens of equal dignity, rank and priority with the lien on such premises of state, county, school and municipal taxes for the amount therof upon the real property served. (WV code 8-19-12a).

Fourth: In the case of a landlord/renter situation, any bill that remains unpaid for a period of thirty days after the same becomes due and payable, the landlord will be notified of such.

Fifth: This application shall not be binding until approval of the municipality is written thereon, but shall bind both parties for the services consumed to such time, but the action upon said application shall not be unnecessarily delayed.

Sixth: Immediate notification will be given to the utility office at City Hall of any change of the character or type of service.

Seventh: Current phone number will be maintained with office for office use in case of emergencies and other notifiactions.

I hereby certify that I have read the aforesaid and agree to the terms al listed above.