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   Complete the information below if your utility service was stopped because your property has been unoccupied, but you are going to return soon and would like to have your utility services reinstated.

5. Name (first and last):*
6. Please confirm your current phone number:*
8. Please confirm your email address:*
10. Service Address:*
12. What date should services be reinstated?*
    What date should services be reinstated?

    If you need your water turned back on, please be sure to choose a week day.  
    The City cannot restore water service on weekends or holidays.

14. Does the City need to turn your water back on?*
    -- Select One --YES - Please restore my water service on the date listed above.NO - My water is on. I just need to resume billing.
16. IMPORTANT - Please acknowledge the terms below by entering a check mark:*

    1. I understand that I will be responsible for the monthly sewer flat charges, monthly street light charges, and monthly storm water charges that have accrued while billing was ceased. I agree to pay these charges, in addition to the trip charges above, upon my return.
18. IMPORTANT - Please acknowledge the terms below by entering a check mark:*

    1. I understand that I must provide the City at least three (3) business days notice to have the water service restored.
    2. I understand that I will be charged $35.00 for the trip to disconnect the water, and another $35.00 for the trip to reconnect the water.
    3. I understand that I will be responsible for the monthly sewer flat charge, monthly street light charge, and monthly storm water charges that have accrued while billing was ceased. I agree to pay these charges, in addition to the trip charges above, upon my return.
    4. I understand that in certain circumstances, the City of Monroe may not be able to turn the water off at the street valve. I understand that it is my responsibility to turn water off at the main valve inside the home in order to prevent water leaks and water damage. The City will not be held responsible for compensatory damages due to water leakage in my home during my absence.
20. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
22. Electronic Signature*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field