Forms • Highland City, UT • CivicEngage

Utility Agreement/Account Set Up

Leave This Blank:

"The monthly charges for all city provided services shall be billed to the record owner of the property whether the property is owner occupied, or renter occupied." Highland City Municipal Code 13.30.300. Highland City does not allow Renters to set up utility accounts.

Please complete the following information. Once you submit your request it will be reviewed and processed within a few business days. Watch for an email reply with account details and information.

Name of Property Owner:*

Name of Additional Property Owner:

Service Address:*

Mailing Address (if different from service address):

City:

State:

Zip:

Primary Phone Number:*

Alternate Phone Number:

Email Address:*

Alternate Email Address:

Occupancy Date (the date new homeowner has taken legal possession of the home or when the new homeowner closed on the home):*

Number of garbage cans presently at the home (green with green lids). If unknown, please leave blank and add notes to the comments.

Total number of garbage cans wanted:

1st garbage can $10.98/Month
Additional garbage can(s) $7.72/Month. Additional cans ordered must be kept a minimum of 12 months or a $10 can retrieval fee will be charged. If you would like a brand new can, to exchange out the old can for a new one will incur a $51.59 fee.*

Number of recycle cans presently at the home (green cans with blue lids). If unknown, please leave blank and add notes to the comments.

Total number of recycle cans wanted:

Recycle can(s) $7.18/Month per can. Additional cans ordered must be kept a minimum of 12 months or a $10 can retrieval fee will be charged. If you would like a brand new can, to exchange out the old can for a new one will incur a $51.59 fee.*

Please attach a closing document which includes dates, purchaser's name(s), and the service address for the property. For new construction, please upload any document from your builder if a closing document isn't available. Be sure to check the "Convert to PDF" box after uploading your file.*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Additional requests/notes, if any.

I/we undersigned, hereby apply for services with Highland City for the above named premises and agree to pay any and all charges incurred for said services in accordance with rates fixed by Highland City. Failure to pay my/our bill by the 20th of the month will result in a 3% late fee for each month the bill remains unpaid.

My/our failure to pay my/our bill for a period of 30 days or my/us having an excessive balance, will result with discontinuance of my/our service(s). A re-connection fee of $80.00 plus payment of all outstanding balances must be paid in full before service will be restored. Services will not be restored after hours. I/we further agree to allow Highland City’s personnel to enter upon such property to terminate services when I/we have been delinquent in the payment of services, provided I/we have been notified of such proposed termination and the reason thereof prior to such termination.

Any returned payments are subject to $20 returned payment fee for each instance.

I/we agree to pay all reasonable attorney fees and any and all other cost incurred by Highland City to obtain collection on this account.*

Yes I agree

No I do not agree

Notice_Additional Permits and Applications

I have read the Notice Additional Permits and Application form to abide by its requirements and obligations.*

Yes

Upon completing and pressing submit, your application will automatically be submitted to Highland City staff (please only complete & submit once).

You will then automatically be taken to Xpress Bill Pay's website where you will be required to complete the payment steps to pay the $25 account set up fee. If payment is not received, the application will be held until payment is received and verified.

INTERNAL USE

Subdivision:
Plat:
Lot:
Building Permit #:
Account #:

Lot Square Footage =

Open Space District?:

Culinary Meter ID/EMR ID:
Culinary MXU ID/MXU Port ID:
Culinary Meter Reading Date:
Culinary Meter Reading:
Latitude & Longitude:

PI Meter ID/EMR ID:
PI MXU ID/MXU Port ID:
PI Meter Reading Date:
PI Meter Reading:
Latitude & Longitude:

Payment Received:
Proof of Ownership:
Process Date:

* indicates required fields.

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