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Form preview Can you fax 2 forms of id to m... By affixing his her or their signatures hereto customer s acknowledge that they have previously granted MLGW permission to perform a credit assessment for the purpose of confirming the identity of the customer and determining the amount of any required deposit MLGW USE ONLY Customer No. Premise No. Deposit Amount Paid Remarks MLGW Representative ATTACH IDENTIFICATION HERE Area Number Date. It is agreed by the customer and MLGW that this contract shall apply to the original address of the customer and to all future addresses of the customer which receive service from MLGW. Information submitted to MLGW in this service agreement is correct and true to the best of the undersigned s knowledge and belief. If a customer or individual within the household is dependent on 24 hour electrical operating equipment to sustain life medical certification of the health condition and the type of equipment used must be provided to MLGW. MLGW will determine and contact the customer if the equipment qualifies for the Life Support Program. This program alerts MLGW s distribution area of the urgent need for electricity on the premise. MLGW shall not be responsible for damages incurred due to lack of service. The Life Support Program does not relieve the customer from full payment of utility bills. EXHIBIT G MEMPHIS LIGHT GAS AND WATER DIVISION RESIDENTIAL SERVICE AGREEMENT PLEASE TYPE OR PRINT Last Name Home Telephone No. First Name M. I Maiden Name Date of Birth Service Address Apt. No. City Zip Code Marital Status Circle One Single Married Mailing Address if different from Service Address Do You Own Rent Date of Purchase of Lease Name of Landlord or Apt. Complex Immediate Prior Address Prior Service w/MLGW Yes No Social Security No. Driver s License No. and State Name of Employer Address Nearest Relative not living with you Name of Spouse Or Co-Applicant Applicant s Signature Date Print Maiden Name Social Security No. 2014 Customer Care Information Guide vii Terms and Conditions MLGW appreciates customers who establish and maintain good pay records. The customer shall pay all collections expenses attorney fees and court cost if payment is delinquent due to fraud default or failure to perform the obligations incurred and set forth in this agreement. It is agreed by the customer and MLGW that this contract shall apply to the original address of the customer and to all future addresses of the customer which receive service from MLGW. Information submitted to MLGW in this service agreement is correct and true to the best of the undersigned s knowledge and belief. If a customer or individual within the household is dependent on 24 hour electrical operating equipment to sustain life medical certification of the health condition and the type of equipment used must be provided to MLGW. MLGW will determine and contact the customer if the equipment qualifies for the Life Support Program. This program alerts MLGW s distribution area of the urgent need for electricity on the premise. If your pay record does not meet these requirements your deposit s will be held until utility services are terminated and applied to your final bill. The undersigned s hereby makes application for utility service s and agrees to pay for said service s as measured by Memphis Light Gas and Water Division s metering devices in accordance with the application rates and charges as specified in MLGW s rate schedule for the above account and any account requested by the undersigned from MLGW. The customer agrees to allow right of access to MLGW s agent s on the customer s premises at all reasonable times and for necessary purposes. Complex Immediate Prior Address Prior Service w/MLGW Yes No Social Security No. Driver s License No. and State Name of Employer Address Nearest Relative not living with you Name of Spouse Or Co-Applicant Applicant s Signature Date Print Maiden Name Social Security No. 2014 Customer Care Information Guide vii Terms and Conditions MLGW appreciates customers who establish and maintain good pay records. Customers with 24 consecutive months of service beginning when the deposit was established may be eligible for a deposit refund. MLGW will refund Residential deposits within 30 days based on A-Rating with the following conditions no arrears balance no delinquent service order generation during the previous 24-month period no delinquent reconnects during the previous 24 month period no returned checks stopped payments or credit card reversals in the previous 24-month period. The undersigned s assume responsibility of service beginning from connection date or until MLGW is properly notified of cancellation of service and agree that all billing rendered by said company shall be due and payable as per the bill. Failure to receive a bill does not release a customer from payment obligations.

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