Forms • Perkins, OK • CivicEngage

Transfer Service within the City of Perkins

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Please complete the online form below to transfer water/sewer/trash service from your current address in Perkins to your new address in Perkins. A $25 transfer fee will be applied to your next bill.
Account Information
Select type of address:*
Name on Current Utility Account*
NEW Service Address*
Date to Begin Service (MM/DD/YYYY) (Cannot be back-dated)*
Landlord Name (If Applicable)
Landlord Phone (If Applicable)
CLOSING Service Address*
Date to Terminate Service (MM/DD/YYYY) (Cannot be back-dated)*
MAILING Address*
Account Holder Last 4 Digits of Social Security Number*
Account Holder Driver's License Number*
Account Holder Driver's License State*
Account Holder Date of Birth (MM/DD/YYYY)*
Account Holder Maiden Name (If Applicable)
Home Phone Number
Cell Phone Number
Employer
Employer Phone
Spouse Name
Spouse Phone
Contact Information
Your Full Name*
Email Address:*
Cell Phone Number*
Service may be refused to a customer when there remains an unpaid account for services previously provided. Also, the utility shall not be required to provide service to an applicant who uses an alias, trade name, business name, or the name of a relative or other person as a device to escape payment of an unpaid obligation. The City of Perkins may require payment of unpaid utility bills of any other person when a previous customer with an unpaid account remains an occupant or user of the customer. Any delinquencies for one address to a customer’s credit may be transferred to any other address to which a customer requests service in the future or in which a customer may reside, irrespective of the name of the account. If at any time, some portion of the account becomes delinquent, service may be terminated. If any delinquent account is turned to collection or attorney, or if suit is filed, all costs and attorney fees associated therewith, fees, costs, and expenses of up to 35%, shall be added to the delinquent amount and collected as part of the delinquent account. It is the customer’s responsibility to apply for the proper type of service. The undersigned applicant certifies that the said applicant has read and understands the terms of this agreement. Customer agrees to comply with and abide by the above terms and all rules and regulations promulgated by the Perkins Public Works Authority now existing or hereafter adopted. Customer further understands that information contained on this form is a matter of public record with the exception of credit information and may not be withheld from anyone who properly requests such information. Customer agrees to allow the City of Perkins to request information contained on their credit report for the purpose of establishing the amount of deposit required for services. This deposit is made as security for payment of sums due the City of Perkins for water, sewer, and/or trash collection which customers may now or hereafter apply and receive at the above premises. This deposit will be refunded after discontinuation of all such services and payment of all sums due. Please select "Yes, I agree" below to indicate you have read and agree to this information.* Yes, I agree
LifeNet enrollment options will remain the same as my previous utility account. I understand that I may opt out during the WPCATA open enrollment period. Please select "Yes, I agree" below to indicate you have read and agree to this information.* Yes, I agree
Right to Privacy Policy - According to Oklahoma Open Records Act Although they must provide public access to their records, including records of name, address, rate paid for services, charges and payment for each customer, public bodies that provide utility services to the public may keep confidential credit information, credit card numbers, telephone numbers, and bank account information for individual customers. Please select "Yes, I agree" below to indicate you have read and agree to this information.* Yes, I agree
Electronic Signature
By typing your name below, you are attesting that you are the account holder or that you are acting with the account holder's full knowledge.
Electronic Signature: Type your name to confirm your request.*
Today's Date (MM/DD/YYYY)*
Sometimes technology has glitches. If you have not heard from us within 24 business hours of submitting your form, please call us at (405) 547-2445.* Yes, I understand

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