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Business Application Page1of2

Name of Business*
Address*
Service Address
City*
State
Zip Code
Owner First Name*
Legal First Name and Middle Name if applicable
Owner Last Name*
Legal Name with suffix if applicable (Ex -Sr, Jr)
First Name*
Legal First Name of person requesting service on behalf of business.
Last Name*
Legal Last Name of person requesting service on behalf of business.
Phone Number*
Phone number of person requesting service.
Phone Number
Alternate Number (work, etc.)
Email Address
Mailing Address
If different from service address
City
State
Zip Code
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BusinessApplication Page 2 of 2

Requested Service Date*
Requested Service Date
Date service is to begin
Driver's License /ID*
Upload Scanned Copy of Driver's License or ID
Upload Rent/Lease Agreement *
If Owner, Upload First and Last Pages of the Purchase Agreement
If Renting or Leasing, Upload Agreement
Upload Occupational License*
Inside City must provide proof of City and County Occupational License.
Outside City must provide proof of County Occupational License.
Alarm System*
1. Yes
2. No
Does Residence have an Alarm System?
If Yes,
Please Request Alarm Registration Form.
Prevent Fire/Water Damage
To prevent fire or water damage, make sure all electric appliances and water faucets are turned off prior to the scheduled connect date.
Solid Waste Collection Service
Please contact the Solid Waste Department by calling 863-534-0181 or emailing Solid Waste SolidWaste@cityofbartow.net to establish waste collection service.
ADMINISTRATIVE FEE
A $20.00 one-time administration fee will appear on your first bill.
CREDIT ASSESSMENT FOR DEPOSIT
If you qualify to pay no deposit or a reduced deposit at Service Initiation and your service is suspended for non-payment, you will be required to pay additional deposit equal to two time the average bill
For Temporary Services, there is a deposit fee of $50
Service Requirement
The City of Bartow contracts meter readers to visually read all utility meters every month. With that said, it is required that customers provide clear and safe access to all electric and water meters located at every location. If you have any questions regarding access, please contact Customer Service. 863-534-0188 or csr@cityofbartow.net
METER TAMPER
If for any reason your meter seal is cut, pulled through or broken, a meter tampering fee will be added to the account and a deposit equaling 2 times the average bill will be required.
Applicant Signature*
Acknowledgement/ Consent*
1. This is My Signature
By Checking this box, I acknowledge all information provided is true and correct including my provided signature.
Incorrect information may result in disruption of service or additional service charge.

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