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Utility Application & Agreement 12.22

  2. Type*
  3. This Service Address is:*
  4. If commercial location, please list the following:
  6. Service Requested*

    Val Verde annexed properties will continue their existing water services. No change is necessary.

  7. Number of Garbage Cans Requested:
  8. Number of Recycling Cans Requested
  10. (Please specify the type and number of each.)

  11. (Please specify the type and number of cans to be removed.)

  12. (Please specify the type and number of cans to be delivered.)

  13. xpressbillpay
  14. Online Bill Payment

    After you have received your first monthly utility bill you may sign up for online bill pay by visiting You may also request PAPERLESS billing when you enroll.

  15. Disclaimer & Signature
    I hereby represent that I am the owner of the above mentioned property and wish to apply for the City of North Salt Lake utility services. I agree to abide by all pertinent ordinances and regulations of the City. I agree to pay, when due, the established charges for such services whether supplied to myself, tenant or other occupant. I further agree to be responsible for any garbage collection containers furnished by the City of North Salt Lake. I agree that the City may shut off the water for failure to pay for the charges when due, and that if a turn off is made, all arrears for service, including turn off and turn on charges, shall be paid in full before service is restored. In the event action is required to enforce this agreement, I agree to pay all costs including late fees, collection costs, and reasonable attorney's fees.

    Your electronic signature below indicates your agreement with the following statement: By typing my name in the following box and clicking the submit button I certify the information provided on the application is accurate and true.
  16. Leave This Blank:

  17. This field is not part of the form submission.