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2. Vacation Status will only apply to permanent residential homes, with a current utility account. The account may remain on vacation status for a minimum of 90 days and a maximum of 180 days. This rate can only be utilized one time in a twelve-month period. No property in the process of being sold will be eligible for vacation rates.
4. Date Vacation Status Requested to Begin*
   Date Vacation Status Requested to Begin
6. Account Holder's Full Name*
8. Account Number*
10. Service Address*
12. City*
13. State
14. Zip Code
16. Mailing Address*

    While you are away

18. City*
19. State*
20. Zip Code*
22. Phone Number*

    In case we need to contact you while you are away. 

23. Email Address

    In case we need to contact you while you are away.

25. Electric and Water Services will remain on and a monthly bill of $38.78 plus usage (inside city) or $35.41 plus usage (outside city) must be paid each month. The minimum monthly charges break down as follows:
27. Inside City

    Electric                      $9.40

    Water                         $13.19

    1/3 Sewer                   $7.61

    Garbage                     $8.58

    Total Base Charges $38.78 Plus Usage

28. Outside City

    Electric                      $9.40

    Water                         $16.49

    1/3 Sewer                   $9.52

    Garbage               

    Total Base Charges $35.41 Plus Usage

30. I understand that I must give at least a seven-day notice before returning so that my account may be taken off vacation status. I also understand that the City of Bartow is not responsible for any electrical problems or water damage from services being left on while I am away.
32. Customer's Signature*
33. Acknowledgement /Consent*

    1. This is My Signature / I Agree

    By Checking this box, I acknowledge all information provided is true/correct including my provided signature and that I have read, understand and agree to the terms and conditions of this application.

    
    

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

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