I hereby request utility service from the Town of Beech Mountain at the address or
property stated below. In requesting utility service, I accept full responsibility for
any charges, fees, penalties or other obligations incurred by the account. I also agree
to abide by all present and future rules and regulations of the Town that apply to the
utility system. I acknowledge that I have been furnished with a copy of all current
regulations that apply.
Customer Name (please print): __________________________________________________________
Lot Number: __________________________________________________________
Street Address: __________________________________________________________
Billing Address: __________________________________________________________
__________________________________________________________
__________________________________________________________
E-Mail Address: __________________________________________________________
Phone: __________________________________________________________
Date service is to be turned on: _______________________________________________________
Are you a permanent resident? _____Yes _____No
Security deposits are required of all utility customers. The current deposit for the
residential service is $50 for water and $50 for sewer service. The current deposit for
commercial properties is $75 for water and $75 for sewer service.
RESIDENTIAL COMMERCIAL
Deposit Enclosed: WATER ___________ ___________
SEWER ___________ ___________
TOTAL ___________ ___________
If service is or was disconnected at this location by the previous customer prior to the
service date requested above, a turn-on fee of $25.00 will be charged to the applicant
and included in the first month's bill.
_______________________________________________________ __________________________
Signature of customer or authorized agent Date
Make deposit check payable to: BEECH MOUNTAIN UTILITIES
Deliver or send to: Beech Mountain Town Hall , 403 Beech Mtn. Parkway , Beech Mtn, NC 28604-8012
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