STATE OF
}
CONTRACT FOR SERVICES
SERVICE FEE:
$50.00
DATE
SERVICE TO BEGIN ____/____/______
________________________________________________
_________________________
LAST NAME
FIRST NAME
(Please print)
SOCIAL SECURITY #
________________________________________________
_________________________
LAST NAME
FIRST NAME
(Please print)
SOCIAL SECURITY #
___________________________________
_____________________________________
Email address (optional**)
Home phone and/or alternate number (optional**)
I certify that I
am the OWNER ( ) BUILDER ( ) LESSEE ( ) AGENT OF OWNER ( )
["Customer"] and contract with the LAKEWAY MUNICIPAL UTILITY DISTRICT
to provide water, and/or wastewater service to the following property.
SERVICE
ADDRESS: ___________________________________
BILLING
ADDRESS: __________________________________
_____________________
Does Customer
have or intend to have a ‘grinder pump’ system?
YES ( )
NO ( ).
If yes, Customer agrees to abide by and be bound by the attached Addendum
to Service Contract.
The Customer
agrees to pay all established rates, charges and fees, and to comply with all
rules and regulations of the District now existing or revised.
The District will maintain a copy of this contract as long as the
Customer and/or the premise is connected to the Water and/or Wastewater System.
The Customer
grants to the District, any easements or rights-of-way for the purpose of
installing, inspecting, maintaining, and operating pipelines, meters, valves and
any other equipment that may be required to extend or improve service for
existing or future Customers. The Customer agrees to waive, release, and hold
the District harmless from any claims and damages resulting from malfunction,
failure, or absence of check valves, backflow prevention devices, and pressure
relief valves, including without limitation, damages to persons or property,
direct damages, special damages, incidental damages, consequential damages, or
loss of profit or revenue.
The District has
adopted the 2000 Edition of the Uniform Plumbing Code (Code) with Local
Amendments. All plumbing work done
in the District must meet the requirements set forth in the Code.
DEPOSITS – A
non-interest bearing Security Deposit and a $50.00 service fee is required for
each new service account. The
District reserves the right to increase the amount of the deposit for any
existing account. The deposit will be based on current deposit requirements or
the highest billing for the previous six (6) billings, whichever is larger.
If service is terminated for non-payment, where previously a Security
Deposit was not required, a Security Deposit and payment of all other applicable
fees will be required prior to the restoration of service.
After one year of timely payments, the deposit may be applied to your
account. If the account is finaled,
the deposit, if any, will be applied upon termination of the account to the
final bill and any remaining amount refunded.
The District
offers bank/credit card drafting to customers for convenience of payments.
If a residential customer chooses to use drafting at the time of signing
up for service, the Security Deposit will be waived.
On a second occurrence of a bad "draft" in a 12-month period, a
full deposit will be required to continue service.
A deposit will not be required if a new customer presents a letter from
another utility company on its letterhead stating satisfactory credit history
for the previous year.
BILLING – The
District uses a two-month billing period. Bills
are mailed out on or around the first of February, April, June, August, October
and December. A 10% penalty is added
if payment is not received in the District Office before the 20th of
the billing month. If payment is not
received by the 25th day of that month, the District will mail a
notice of intent to terminate service. In accordance with the District’s Rate
Order, service will be terminated on the 10th day of the following
month if full payment is not received. A Customer’s obligation to make timely
payments for service is not released or diminished because a bill was not
received. Returned checks will not
be redeposited, a $25.00 charge is added and the service is subject to
termination.
RESTORATION OF
SERVICE – A reconnection fee of $50.00 is required with all other amounts due
before the service is restored. Payments
must be received during normal business hours for service to be restored the
same day. If service is restored by
anyone other than the District, the meter will be locked or removed and a fee of
$100.00 will be charged.
PAYMENTS – All
payments must be made at the District Office.
The 1993 Texas
Legislature provided for any customer who wishes to exercise the privilege of
keeping confidential their address, telephone number, or social security number
to file same with the providing utility company.
This request for confidentiality does not prohibit the District from
disclosing personal information in a customer’s account record to an official
or employee of the state, an employee of the District acting in connection with
the employee's duties, a consumer reporting agency, a contractor or
subcontractor approved by and providing services to the District, a person for
whom the customer has contractually waived confidentiality for personal
information, or another entity that provides utility services. If you wish to
exercise this right, please initial the adjacent line __________.
SIGNATURE:
___________________________
SIGNATURE: ____________________________
DATE:
__________________________
DATE: __________________________
Approved
and accepted by the District: ________________________________________
District Office Personnel
Card type: V______ MC______ D______ AE______ Expiration Date __________________
3
(4 for AE) digit Security Number ________________
(Found on back of card)
________________________________________
______________________________________
Credit Card Number
Name on Credit Card
______________________________________
___________________________
I, _____________________________________,
authorize Lakeway Municipal Utility District to charge my credit card for the
service fee and/or appropriate security deposit to establish service.
NOTE: THIS
CREDIT CARD AUTHORIZATION IS ONLY FOR THE SERVICE FEE AND/OR SECURITY DEPOSIT.
FOR RECURRING CREDIT CARD DRAFTING, PLEASE COMPLETE AUTHORIZATION
AGREEMENT FOR AUTOMATED CHARGES
LAKEWAY MUNICIPAL UTILITY DISTRICT
1097 LOHMANS CROSSING
LAKEWAY, TX 78734
512/261-6222
512/261-6681 fax
(please call to verify receipt
of fax)
email: mdiaz@lakewaymud.org
LAKEWAY MUD NOW OFFERS
"AUTOMATIC
CREDIT CARD PAYMENTS"
You
are now able to have your water bill paid automatically by charging your credit
card with no fees involved. Before
we can do this, we need your written
authorization. Please fill
out the following information, sign and date, and return to the District Office
as soon as possible. Your credit
card will be charged on or before the last date of the grace period.
Participation in this program will automatically assure timely payment to
avoid penalties. We will still send
you a bill so you will know the amount of the charge.
It is the responsibility of the customer to notify the District Office of
any changes of billing address, expiration date, or type of credit card to be
charged.
*******************************************************************************************************************
AUTHORIZATION AGREEMENT
FOR AUTOMATED CHARGES
(Separate
Authorizations for EACH Account Required.)
____________________________________________________________
Account Name (Last, First, M.I.) [Please Print]
______________________________________
________________
Service
Address [Street]
Zip Code
I (we) hereby authorize the Lakeway
Municipal Utility District to initiate charges to my (our) credit card
indicated below.
This authority is to remain in full force and effect until the Lakeway
Municipal Utility District has received written notification from me (or
either of us) of its termination in such time and in such manner as to afford
the Lakeway Municipal Utility District
a reasonable opportunity to act upon it.
Credit Card Number______________________________ 3 (4 for AE) Digit Security Number _________
MANDATORY
Expiration
Date __________________
Card Type: V______ MC______ D______ AE______
V=Visa, MC= MasterCard, D=Discover, AE= American Express
__________________________________________________
______________________
Customer Signature
Date
----------------------------------------------------------------------------------------------------------------------------------------
LAKEWAY MUNICIPAL UTILITY DISTRICT
1097 LOHMANS CROSSING
LAKEWAY, TX 78734
512/261-6222
512/261-6681 fax
email: mdiaz@lakewaymud.org
Want
To Always Be Sure Your Bill Is Paid On Time And Avoid Writing Checks To Lakeway
MUD ??
WE
ARE NOW OFFERING "AUTOMATIC BANK DRAFTING"
You
are now able to have your water bill paid automatically by a debit to your
checking account with no fees involved.
Before we can do this, we need your written
authorization and a copy of a voided
check from your bank account. Please
fill out the following information, sign and date, and return with a voided
check to the District Office as soon as possible.
Your bank account will be charged on the last date of the grace period.
Participation in this program will automatically assure timely payment to
avoid penalties. We will still send
you a bill so you will know the amount of the draft.
The first drafting of your account will occur on the next billing period
after receipt of this agreement.
************************************************************************************************************
AUTHORIZATION
AGREEMENT FOR AUTOMATED PAYMENTS
(Separate
Authorizations for EACH Account Required.)
______________________________________
__________________________________
Account
Name (Last, First, M.I.) [Please
Print]
______________________________________
Service
Address [Please Print]
I (we) hereby authorize the Lakeway
Municipal Utility District to initiate debit entries to my (our) checking
account indicated below and the DEPOSITORY named below to debit same
to such account. A voided check (or copy of same) is enclosed.
This authority is to remain in full force and effect until the Lakeway
Municipal Utility District and the DEPOSITORY have received
written notification from me (or either of us) of its termination in such time
and in such manner as to afford the Lakeway
Municipal Utility District and DEPOSITORY a reasonable opportunity to act
upon it.
DEPOSITORY
NAME (your bank) ________________________________________________
__________________________________________________
______________________
Customer Signature
Date
LAKEWAY MUNICIPAL UTILITY DISTRICT
1097 LOHMANS CROSSING
LAKEWAY, TX 78734
512/261-6222
512/261-6681 fax
email: mdiaz@lakewaymud.org
Check List:
Step One:
_____ First page of Service Contract
Note: all blank fields must be completed
Step Two:
_____ Second page of Service Contract
_____ Send in $50 check for non-refundable service fee with Service Contract
OR
_____ Authorization to charge credit card for $50 non-refundable service fee
Note: all blank fields must be completed
Step Three:
_____ Send in check for deposit
OR
_____ Authorization to charge credit card for bi-monthly bills
Note: all blank fields must be completed
OR
_____ Authorization to draft bank account for bi-monthly bills
Note: all blank fields must be completed
Note: need copy of voided blank check
OR
_____ Send in Letter of Credit
Step Four:
_____ Call to confirm receipt
OR
_____ Email and ask for confirmation