Utility Water Bill

UTILITY WATER BILL

Account and Service Information

Account Number:   Bill Date:   Due Date:

Meter and Usage Summary

Meter Number:   Previous Reading:   Current Reading:

Multiplier:   Consumption (units):

Charges

Service Charge: $   Usage Charge (@ rate per unit): $

Usage Charge Total: $   Other Charges: $

Taxes and Assessments: $   Adjustments/Credits: $

Total Current Charges: $   Past Due Balance: $

Total Amount Due: $

Payment Options and Notices

Payment Method (select all that apply): Auto Pay Pay by Mail Pay In Person

Late Payment Fee: . Payments received after the due date are subject to suspension of service after notices and applicable collection procedures.

General Service Agreement

WHEREAS

WHEREAS, Utility Provider: provides potable water supply and related services to customers within its service territory; and

WHEREAS, Customer Name: requests continued water service at the Service Address identified above and agrees to the terms and conditions set forth herein;

NOW, THEREFORE, the Utility Provider and Customer agree as follows:

Scope of Work

Payment Terms

Customer shall pay the Total Amount Due by the Due Date indicated on this bill. Standard charges are set out above. Payment schedule: monthly billing in arrears based on meter readings for the stated billing period. Account will be billed on a monthly cycle with payment due by the date shown. Amount due for this bill: $.

Late payment shall incur a fee of per billing cycle on any unpaid balance. Continued nonpayment may result in termination of service after required notice periods and any applicable hearing rights.

Term and Termination

Term Commencement Date: . This Agreement remains in effect until terminated in accordance with its terms.

Either party may terminate service upon providing written notice of days. Utility Provider may also terminate or suspend service for cause, including but not limited to nonpayment, meter tampering, or hazardous conditions, subject to applicable notice and appeal rights.

Confidentiality

The parties acknowledge that certain customer account information is confidential. Utility Provider will maintain customer account information in accordance with its records policies and applicable law. Customer consents to disclosure of billing and service information to collection agents, lien holders, or government authorities where required by statute or to effect collection, service restoration, or public health and safety.

Governing Law and Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the state where the service premises is located. Any disputes arising from this bill or the provision of service shall be subject to the exclusive venue of a court of competent jurisdiction in that state.

This bill, together with any applicable tariffs and service rules incorporated by reference herein, constitutes the entire agreement between Utility Provider and Customer with respect to the subject matter herein and supersedes all prior agreements and understandings, whether written or oral.

Customer Notices and Dispute Procedure

If Customer disputes any portion of this bill, Customer must notify Utility Provider in writing within days of the bill date. Notification must include account number, billing period, disputed amount, and reason for dispute. Failure to timely notify shall constitute acceptance of the bill.

Remittance Stub (Detach and Return)

Account Number:   Amount Enclosed: $

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