Charlottesville Utility Billing Application - Resident

1) Name:

Last  First

2) Social Security Number:

3) Address for Service:

City  State  Zip Code

4) Mailing Address for Billing:

City  State  Zip Code

5) Date Service Needed ( We do not work Utility Applications on Saturday and Sunday. We do not work applications on the same day as the application is submitted):

6) Have you had service with the City previously/currently?

Yes   No

7) If yes, previous or current address:

Address City  State  Zip Code Dates of Service

8) Daytime Contact Phone Number:

9) Are you applying for gas service?

Yes   No

How will we get in to light your gas appliances? We need to get in even if you have electronic pilot lights and an adult will need to be present during our service call. We do not provide same day service. You may request a business day in the future. If you are submitting your application before 5:00 pm on a business day, or over the weekend you may request the next business day at the earliest. Applications submitted after 5:00 pm Monday - Thursday can be scheduled for the 2nd coming business day at the earliest. You may ask for morning (7:30 to 12:00) or afternoon (12:00 to 4:30). If you are not there, or do not have access to all gas appliances when we come to cut on your gas we will not reschedule until at least the next business day and there will be an additional service charge for each return trip.

10) Are you applying for water service?

Yes   No

11) Email Address

12) Comments/Questions: