2. Commercial Service Contract
4. FOR OFFICE USE

   New Account ___      Transfer Fee ___      Modification ___                       

   Account Number: _______-___________-_______

   Bad Debt Search completed: ___      Application Fee added: ___       Deposit Amount: $ __________

   Services Verified: 

   Commercial Water ___      Sanitation ___      Sewer ___      Commercial Trash Receptacle ___      

   Users Fee: $ __________      Water Fee: $ __________

   Inspection Completed: ___      Service Order Sent ___      Clerk Initials ___

6. ***$20.00 Application Fee Will Appear on First Month's Bill***

   All fields below are required to be completed as well as a passed inspection with Community Development. 

8. Business Name*
10. Service Address *
12. Name of Responsible Party*
14. Type of Business: *
15. Please Check One*

    1. Sole Proprietor
    2. Partnership

    1. Corporation
    2. Other
17. Send All Billings to (Street Address): *
18. City, State, ZIP*
19. Attention: *
21. Federal ID# (If Applicable)*

    If no FEI# is available, list SSN of owner and drivers license number and state. 

23. Business Phone #*
24. Other Phone:
26. Email Address*
28. If Renting, Name of Property Owner: *
29. Owner Phone Number: *
31. Have you previously had residential or commercial utility services with the City of Chickasha? *

    1. Yes

    1. No
33. If so, when?
34. Previous Service Address?
38. City of Chickasha Contract for Utility Service

    The applicant and co-occupant agrees to pay the established rates set forth by the City of Chickasha ordinances and resolutions and agrees to the regulations governing said service. This application becomes a contract upon the establishment of services. Under Article 10, Section 17, Oklahoma Constitution, the City of Chickasha is required to collect all fees and charges for utility services provided to its customers. Applicant must be 18 years or older to apply, unless married. If the name (responsible party) is changed on the account being billed, then a new application and service order is required and must be signed by the previously billed party. If other persons not named on this application are authorized to make changes to your account, the completion of an Agent Authorization form may be required.

    Deposits are required as a promise to return utility meters in good condition and as a guarantee that all bills will be paid in full. Deposits belong to the party being billed and are refundable upon termination of service less any outstanding balances due the City. Deposits may be refunded to the customer according to city policy and ordinances.

    The City of Chickasha may disconnect or temporarily suspend services at any time without notice for the following issues: 

    1. If a condition exists that is dangerous or hazardous to life, physical safety or property.
    2. Upon any order of a court or other duly authorized authority.
    3. Detection of fraudulent or unauthorized use of any utility service or the detection of any tampering with service meters and the utility has reasonable grounds to believe customer is responsible for the use or tampering. Theft of services is a punishable offense as detailed in the city code of ordinances and shall be dealt with appropriately.
    4. Failure to pay past due amounts from previously terminated utility services.

    The City of Chickasha may disconnect or temporarily suspend services at any time with notice for the following issues: 

    1. Failure to pay the amount due as stated on their utility billing statement on the required due date.
    2. Customer requests to terminate services.
    3. Failure to pay deposit or failure to pay any additional deposit that may be required.
    4. Issuance of a NSF check for payment on account or payment of deposit. Note: customers are required to address NSF checks within 24 hours of notice.
    5. Violation of utility rules or regulations

    Upon disconnection of services, having service meters pulled or otherwise turned off for nonpayment, the utility account will become subject to reconnect fees as set forth in the City of Chickasha Master Fee Schedule.  The account may be subject to additional fees as set forth in the City of Chickasha Master Fee Schedule.

    **SOMEONE IS REQUIRED TO BE PRESENT WHEN SERVICES ARE TURNED ON OR OFF** 

    COLLECTION OF BAD DEBT DISCLOSURE: Pursuant to Oklahoma Title 11, Section 22-138, a municipality is allowed to add up to a 35% collection fee to cover the costs of utilizing a collection service. If your account is terminated and the balance is not paid within 30 days of termination, you the customer agree to pay any collection fees incurred in attempting to collect amounts due on your past due account. You agree, for us to service your account or to collect any amounts you may owe, we may contact you by telephone at any number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or emails using any email address you provide us. Methods of contact may include using pre-recorded or artificial voice messages and/or the use of an automatic dialing device, as applicable.

40. Agreement*

    1. I/We have read this Contract for Service and disclosure on collection of bad debt and agree that The City of Chickasha/Chickasha Municipal Authority may contact me/us as described above.
42. Please type your name below. This serves as your digital signature agreeing to this contract.*
43. Title
44. Today's date*
    Today's date
46. File Upload - Lease Agreement/Proof of Ownership*

    Please upload one of the following documents: a copy of your lease agreement (renter) or proof of ownership (homeowner).

47. File Upload - ID*

    Please upload a copy of your valid, government-issued ID. 

Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field