Apply for New Service "*" indicates required fields Δ Property Type Single Family Homeowner Single Family Renter Apartment or Condominium Service Type Requested, Deposit Amount Water Service, Single Family, $75 Water Service, Apartment or Condo, $75 Sewer Service, Single Family, $75 Sewer Service, Apartment or Condo, $75 Have you had previous service with Daphne Utilities? Yes No What was the address of your previous service?What date would you like to start new service? Month Day Year Name Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First MI Last Suffix Email Address Date of BirthMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Last 4 digits SSNDriver License #Driver License StateService Address Address City Zip Code Mailing Address, if different from service address Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Primary Phone*Cell PhoneOther Names to have access to this account*NameDaytime PhoneLast 4 digits of SSN Add RemoveConsent* I have read, understand, and agree to the provisions of the following paragraph.By checking the box below the applicant ("Customer") and The Utilities Board of the City of Daphne, its successors and assigns (collectively, "Utility"), agree that the Utility will furnish gas, water and/or sewer service and Customer will pay Utility for gas, water and/or sewer service subject to Utilities rates, charges, applicable city ordinances, applicable state law, applicable federal law or other applicable regulation, as such rates now exist and are on file at the offices of Utility and may hereafter be altered or amended from time to time with or without notice to Customer, Customer further agrees to pay all applicable deposits and agrees that such deposits may be used to pay for gas service, water service, sewer service maintenance service, facilities, connection fees, late fee, collection fees, or other charge, assessment, or fee with or without notice to Customer. Customer further agrees to waive any exemptions as to any amount due under the Constitution and Laws of Alabama, or any other state. Customer further agrees that Utility may conduct a credit check prior to establishment of gas, water or sewer service and may require additional deposits as a result of said credit check. In the event Customer shall breach this agreement by (1) refusing or failing to without just cause to connect to the Department's facility and use same as soon as the facility is available, or (2) refusing or failing to pay Utilities charges for water service, sewer service, maintenance service, connection fees, delinquency charges or other billed charges, fees or assessments. customer acknowledges that utility may, with or without notice to Customer, do any combination the following: (1) collect all past due amounts, (2) Collect any costs associated with collecting unpaid amounts, including attorney's fees, (3) collect interest on past due amounts, (4) disconnect or otherwise discontinue gas, water and/or sewer service, and (5) report delinquency or default to applicable credit bureaus. Customer further acknowledges that service is interruptible at any time. The Customer further agrees to allow utility access to Customer's property (1) as necessary for Utility to survey, install, upgrade, repair, maintain, or inspect existing or contemplated gas, water and sewer pipes, meters, or other facilities and (2) as necessary for Utility to determine usage for billing purposes. Customer further agrees that title to all property installed by Utility remains with Utility and may be removed by Utility at any time, with or without notice. Customer grants utility an easement and right of use along and over the premises for pipes, equipment or other facilities of Utility. Utility reserves the right to reject service to any customer for any reason at any time. Utility is not obligated to inspect or maintain gas, water or sewer service on Customer's property. Customer agrees to release and hold harmless Utility, its directors, its employees and its agents for any damage or injury that may occur as a result of any gas, water or sewer connection, disconnection, repair, maintenance, upgrade, usage, failure, survey or inspection by Utility. Establish New Service UPON COMPLETION and ACCEPTANCE, a representative of Daphne Utilities will call to confirm your application and establish payment of your utility deposit. By submitting this information to Daphne Utilities, I am formally requesting utility services at the address that I have provided. I also agree to allow Daphne Utilities to process my credit card information to pay for the deposits and fees indicated on my application.