Application For Service

Employer’s Address

Past Service Information
Have you had utilities with the Fort Valley Utility Commission before? *

Yes No
Name

First Name Last Name

Address

Address (*If transfer)

Address where service is requested: *

Address where bill is to be mailed: *

Date new service is requested to be connected: *

Month Day Year
Weekdays only Date Picker Icon
List other persons sharing this residence and paying part of the bill:
DOB of other person

Month Day Year
Date Date Picker Icon
If you are not the home owner, list property owner/landlord information:
Name

First Name Last Name
Phone Number

Fort Valley Cares Program (Round-Up Plus 1)

The Fort Valley Cares Program provides assistance to eligible applicants. Contribution to the Cares Program rounds customer’s utility bills up to the nearest dollar, plus adds an additional dollar. All contributions are tax deductible.
Round-Up Plus 1 Program *

Enrolled I would like to opt out of the Round-Up Plus 1 program
I authorize the Utility Commission to add the following amount to my bill each month in addition to the Round-Up Plus 1: *

None $1 $5 $10
NOTE: You can withdraw from either program at any time by contacting Customer Service.

Signature
Please read and check: *

Not receiving a bill does not relieve me of responsibility to pay the bill.
Please read and check: *

This application authorizes the Utility Commission to conduct a credit check.
Applicant’s Signature: *

Clear
Print Name *

First Name Last Name
Date

Month Day Year
Date
Upload required identification documents *

Browse Files
State ID, Driver License, Passport or Military ID Cancel of
Upload required Proof of Residency *

Browse Files
Warranty Deed or Lease Cancel of
Should be Empty:

Applicant Information