Mapleton City Residential Form

Mapleton City Utility Application - Residential

WARNING: When filling out this form please do not hit your browsers BACK BUTTON. All of the information that you have entered will be lost!

The following will be needed to complete this application.

1. Personal Information of all individuals that will be listed on the account.

Please note that if you want a second individual to have access to account information they must be listed as a joint applicant on this form.
Please submit our ACH-Direct registration form here:
Applicant Information
Set Up Date (mm/dd/yyyy)*
Date you would like utilities taken out of previous owners name and put into your name. Please sign in NO more than 1 month in advance.
Applicant Name*

First NameMiddle NameLast Name
Would you like to add someone as a Joint Applicant (i.e. spouse, etc.)?*
If you would you like anyone else (i.e. spouse, etc.) to be able to make inquiries & changes to your utility account you need to add them as a Joint Applicant.
Joint Applicant (Account info can only be given to individuals listed on this application)*

First NameMiddle NameLast Name
Service Address*
Is Mailing Address Same as Service Address?*
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number *

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
E-mail*
example@example.com
Applicant - Birth Date (mm/dd/yyyy)*
Applicant Employer and Emergency Contact Information
Employer Name*
If self, list business name. If Retired, type Retired, If Unemployed, type Unemployed.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer Phone Number

Area CodePhone Number
Emergency Contact - Closest Relative not living at this address*
Emergency Contact - Relationship*
Emerg. Contact - Phone*
Emerg. Contact - Address (Street Address, City, State, Zip)*
Joint Applicant/Agent Information
Joint Applicant - Birth Date (mm/dd/yyyy)*
Joint Applicant Phone Number
Set Up Fee & Deposit

All CUSTOMERS will be required to post a minimum $150 deposit. CUSTOMERS that sign up for ACH-Direct Pay will have the deposit waived. In the event that CUSTOMER cancels ACH-Direct Pay or has a ACH-Direct Pay payment rejected for insufficient funds CUSTOMER will immediately be required to post a $150 deposit, will be taken off of ACH-Direct Pay, and may have utilities shut off.
Waive the $150 deposit by signing up for ACH-DIRECT PAY?*

YesNo
Customer Authorization for ACH-Direct Pay

Reminder: If you sumit this form between the 12th and 20th of the month, the change WILL NOT be effective for the payment due on the 20th. Your ACH-Direct Pay payment may still pull from your existing ACH-Direct Pay account if one is already set up. To prevent this from happening, you will need to make a manual payment by the 15th.
Financial Institution*
Account Type*

CheckingSavings
Routing Number*
Account Number*
The Routing Number is the first nine digits on the check.

The Account Number is the digits between the routing number and check number.
ACH-Direct Payment Authorization Agreement

I hereby authorize Mapleton City Corp. to initiate automatic withdrawals from my account at the financial institution named above. I understand that payment will be deducted from my account on the 20th of each month or the following business day if the 20th is on a weekend or holiday.

I understand that I am responsible to pay a returned item fee of $20 as specified by the City for any automatic debit that is returned to Mapleton City for any reason. In addition, I understand that I will be removed from automatic withdrawals and that a $150 deposit will be required.

Further, I agree not to hold Mapleton City Corp. responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in withdrawing funds from my account.

This agreement will remain in effect until Mapleton City Corp. receives a written notice of cancellation from me or my financial institution, or until I submit a new/updated ACH-Direct Pay form to Mapleton City.

I understand that if I make a payment using another payment method (i.e. in office with cash or check or online with a card) after the 15th of the month, my automatic payment may still be deducted on the 20th by Mapleton City and I assume responsibility for any bank/credit union fees that may result.
I agree to the ACH-Direct Payment Aurhorization Agreement*

Confirmed
Signature*

Clear
Additional Information
Customer Type*
Previous Owner/Builder/Lender*
Landlord Name*
Landlord Phone Number*
Would you like Utilities to be left on when your tenants terminate their Utility Account? If yes, Landlord will be billed the amount incurred after tenant closes account.*
Mapleton Fiber Internet Service

Get ready to experience the connection and explore the world at light speed! Mapleton City has built a fiberoptic network throughout the city to provide high speed fiber internet to each resident and business. Learn more and sign up for Mapleton Fiber here: https://bit.ly/3KfhDrj
Mapleton City - Residential - Utilities Contract
MAPLETON CITY, a Municipal Corportation of the State of Utah and Applicant listed above hereinafter CUSTOMER do agree as follows:

1. City will provide the following services to CUSTOMER at the service address previously indicated on this Utility Contract: Mandatory Services (please note your Landlord or HOA may pay for some of these services): Pressurized Irrigation (may be exceptions), Storm Drain, Culinary Water, Sewer, Garbage. Services shall be provided in accordance with State law and municipal ordinances and resolutions as requested on the setup form at rates as established by ordinance or resolution of the Mapleton City Council provided that city shall not be responsible for failure to deliver services by reason of strikes, accidents, acts of God, weather conditions, natural disasters - whether declared or undeclared, state or other governmental regulations or any other act, contingency of bar beyond city's control.

2.         CUSTOMER shall pay such fees and deposits as shall be established by the city and shall further be subject to termination of services upon non-payment or failure to comply with rules, regulations, ordinances or laws as established by the city. CUSTOMER acknowledges and agrees to pay minimum water charges even in the event that the premises are vacant for extended periods of time, provided that CUSTOMER may eliminate minimum electric and water charges only by requesting the city to terminate service. In such event, CUSTOMER agrees to pay a reinstatement fee, as set by the city, to restore water services. Utility deposits will be held without interest for an indefinite period of time. CUSTOMER agrees to be bound by the utility policy of the city and also the terms and conditions of the Rate Schedule and to pay applicable rates as established by the city council. The utility deposit is held until the CUSTOMER moves. At that time, it will be applied to the account, and any unused portion will be refunded. A CUSTOMER who fails to post a deposit when requested is subject to termination of service. In the event payment is late, a late fee will be assessed. There will be a charge on all returned checks in the maximum amount allowed by state law, and CUSTOMER agrees to pay the same. Utility service is subject to city ordinances and policies established by the Mapleton City Council.

3.         The City requires free unobstructed access to water and pressurized irrigation meters at all times.

4.         In the event this account is placed with an attorney for collection, either with or without suit, CUSTOMER shall be responsible for all court costs and reasonable attorney's fees incurred thereby.

5.         In the event this account is placed with a collection agency for collection, CUSTOMER shall be responsible for all collection costs incurred including a collection fee of up to 18%, pursuant to the provisions of Utah Code Ann. §12-1-11.

6.         CUSTOMER , if any, hereby warrant and affirm that the information provided on this set up form is true and correct to the best of their knowledge. FAILURE TO PROVIDE TRUE AND ACCURATE INFORMATION MAY SUBJECT YOU TO CRIMINAL PROSECUTION UNDER UTAH CODE S76-8-504. Customer also affirm, understand, and agree to comply with provisions of this utility contract.

7. Federal law requires that we establish your identity by accessing information in your credit report. By submitting this application you are authorizing us to obtain information from your credit report to validate your identity.
Applicant Signature Agreeing to Utilities Contract*

Clear
Security Question*
To verify your identity when making future inquiries about your account the answer to a Security Question may be required.
Security Question Answer*
Previous Account with Mapleton City
Do you need to have your current Mapleton City Utilities disconnected? *
If you are moving within Mapleton and would like to cancel your current utility account please select yes.
Street Address for Mapleton City Utility Account that you would like disconnected*
Date you would like old Mapleton City Utility Account disconnected (terminated) (mm/dd/yyyy)*
Have you and/or your spouse ever had an account with the City?*
If you have a prior account that has a past due balance the past due amount as well as any collection fees will need to be paid in full before services will be provided at the new location. Please call 801-489-5655 to make a payment on the prior account.
Name & Address on previous account(s) *
If have never had account with Mapleton City type N/A in box
Useful Information

City Office hours are Monday through Thursday, 8:00-5:30, and Friday, 8:30-5:00. The city office phone number is 801-489-5655.

Mapleton City does not provide natural gas service. Call Dominion Energy at 800-323-5517 to set up your account with them.

Mapleton City does not provide electricity. Call Rocky Mountain Power at 888-221-7070 to set up your account with them.

To see the new resident information packet click here

Garbage is collected on Monday, Wednesday and Friday depending on your area with exception of certain holidays (New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving and Christmas). For inquiries regarding garbage service, call Republic Services at 801-785-5935.
How many garbage cans would you like?*

1234Other
First garbage can is $11.50, all additional cans are $8.00 each.
Signature

Clear
Should be Empty:

Applicant Information

Applicant Employer and Emergency Contact Information

Joint Applicant/Agent Information

Set Up Fee & Deposit

Customer Authorization for ACH-Direct Pay

ACH-Direct Payment Authorization Agreement

Additional Information

Mapleton Fiber Internet Service

Mapleton City - Residential - Utilities Contract

Previous Account with Mapleton City