CONTRACT FOR SERVICE
UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA Main Phone (305)
295-1000 Customer Service Phone (305) 295-1090 Customer Service Fax
(305) 295-1085
Customer Service Email:
[email protected] Service
Requested in the Name
of________________________________________________________________
Requested By__________________________________ Applicant is the:
Owner __________Tenant __________ Drivers License #
_________________________________________Date of Birth
_________________________ Address of
Service____________________________________________________________________________
Mailing Address
______________________________________________________________________________
E-mail Address
_________________________________________E-Bill/Paperless Bill
_______Yes ________ No Contact Numbers: Cell Phone
______________________ Phone ________________________
Service address is a: Residence _____ Business _____ Applicable
Rate Schedule: _________
RESIDENTIAL HOUSEHOLD AFFIDAVIT: This is to certify that until the
undersigned notifies KEYS in writing, the electrical service
provided to the
above referenced account is exempt from Florida’s Sales Tax for the
following reasons: (1) The electric service provided to this
account will be used exclusively to service a residential household
and the meter will not service any commercial or business
activities. Commercial or business activities include, but are not
limited to,
rental operations that cater primarily to transient guests (hotel,
motels and room rentals), the provisions of day care facilities,
and the performance of any activity that
is not residential in nature. (2) The electrical service provided
to this account will be used exclusively to serve common areas of
residential housing complexes, and
the meter will not serve any commercial or business activities such
as vending machines, coin operated laundry facilities, sewage/lift
station equipment, or any
activity that is not residential in nature. (3) The electric
service provided to this account will be used exclusively to serve
a residential model home. The meter will
not serve any commercial activity such as a sales or business
office, or any activity that is not residential in nature.
Customer Verification (Initial) __________
Service Fee is $40.00 and will be billed on the first billing
statement to the customer. Photo copies of identification and proof
of occupancy on file with KEYS. Deposit Required
$___________________ Start Date: ___________________ Deposit
Payment Credit/Debit Card Information (please provide only if
deposit payment is required): Credit/Debit Card
Number______________________________________ Expiration Date
_______/_______ Credit/Debit Card Security Code________
*Credit/Debit Card payments will be assessed a transaction fee for
processing. I hereby acknowledge and agree this contract is made
subject to the provisions of the Keys Energy Services Customer
Service Policy Manual, which I have been provided, and incorporates
such manual as part of this contract as it exists at the time of
this contract and may be amended as per the last paragraph of said
manual. I also acknowledge and agree that the undersigned, as a
KEYS customer, shall be liable for all applicable sales tax. The
undersigned customer hereby grants the Utility Board of the City of
Key West a security interest in the service deposit provided for
under this agreement to secure payment and performance of all the
debts and obligations arising from the provision of the Utility
Board services to the customer in the ordinary course of business.
The Utility Board will keep possession of the deposit and will
refund the deposit only after all bills charged for services
rendered have been paid by the customer. The customer’s deposit
will first be applied to any outstanding bills owed by the customer
with the remaining balance, if any, being refunded to the customer.
The above customer and the Utility Board have duly entered in this
agreement on ______/______/______. _______ I Accept - I understand
that be checking the box next to the words “I Accept” and typing my
name below, I am signing this document electronically.
KEYS Use Only KEYS Representative___________________________
Account No.: __________________________________
Customer No.: _________________________________
Customer Signature ____________________________________