Create a Website Account - Manage notification subscriptions, save form progress and more.
New Account ___ Transfer Fee ___ Modification ___
Account Number: _______-___________-_______
Bad Debt Search completed: ___ Application Fee added: ___ Deposit Amount: $ __________
Commercial Water ___ Sanitation ___ Sewer ___ Commercial Trash Receptacle ___
Users Fee: $ __________ Water Fee: $ __________
Inspection Completed: ___ Service Order Sent ___ Clerk Initials ___
All fields below are required to be completed as well as a passed inspection with Community Development.
If no FEI# is available, list SSN of owner and drivers license number and state.
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:
The City of Chickasha may disconnect or temporarily suspend services at any time with notice for the following issues:
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.
Please upload one of the following documents: a copy of your lease agreement (renter) or proof of ownership (homeowner).
Please upload a copy of your valid, government-issued ID.
This field is not part of the form submission.
* indicates a required field