Utility Billing Account Forms

Utility Billing Account Forms

CITY OF DELAND UTILITY ACCOUNT APPLICATION/CHANGE FORM

Name

Email Address

Service Address The city of DeLand only services utilities in DeLand

Apt. #:

Phone Number: I understand that my phone number will be used to contact me about my account via any method the City deems appropriate, including automated systems. By refusing to provide my number the City will not be able to contact me about late or delinquent payments.

Are you the property owner? Value is not selected

Are you creating a new/Transfer Account Value is not selected

Utility Billing Account Forms

New Account

Mailing Address (if different)

Social Security Number

Driver's License Number

Driver's License State Value is not selected

Check one

Turn on meter/already on

Leave meter off/already off

Date to Turn On Service: For Same Business Day Turn On $50.00 prior to 4 pm. For Next Business Day Turn On $25.00 Service Fee

Note: Copy of rental agreement or lease must be shown if applicant does not own the property.

Copy of lease agreement Please Attach PDFs only

Copy of Deed or Settlement Statement Please Attach PDFs only

Articles of Incorporation (If you are a business) Please Attach PDFs only

Copy of Driver's License

Customer's Signature:

Utility Billing Account Forms

City of DeLand
Social Security Number Collection Notice

The City of DeLand recognizes that an individual’s Social Security number is a unique form of identification that can be utilized to obtain sensitive information regarding that particular individual. However, the City of DeLand must collect Social Security numbers under certain circumstances in order for the City to be able to properly perform its duties and functions as a municipal corporation and in order to ensure such duties and functions are performed accurately and efficiently.

The City of DeLand collects your Social Security number for the following purposes only:
• Classification of Accounts
• Identification, Verification and Background Checks
• Credit Worthiness or Collections
• Billing and Payments
• Data Collections, Reconciliation and Tracking
• Benefit and Payroll Processing
• Tax Reporting
• New Utility Account Applications
• Vendor Registration Applications
• Volunteer Contracts for Background Checks
• Emergency Transport/ Services for Billing and Insurance
• Police Statements and Arrests for the Verification of Identity

Each individual who provides a Social Security number to the City of Deland shall be provided with a copy of this notice. Additional copies of this Social Security Number Collection Notice may be obtained by contacting City Hall, 120 S. Florida Ave, DeLand, Florida

This Social Security Number Collections Notice has been provided by the City of DeLand with compliance with Florida Status Section 119.071 (5) (2007).

Signature

Utility Billing Account Forms

Do you want to sign up or remove auto pay? Value is not selected

Last 4 Digits of registered Bank Account Number

ABP (Automatic Bank Payment)

Your required payment will be withdrawn from the bank account you designated on the due date of your next bill. Your bill will indicate Bank Draft on the payment stub/coupon when activated. Please continue to pay your bill as normal until your bill indicates “BANK DRAFT”.

FLEXPAY

FLEXPAY allows customers the option of selecting the 15th or 30th of the month as the utility bill due date. I understand that by choosing to participate in ABP or FLEXPAY my first bill may be for a longer or shorter billing period since my utility account will be placed in a different bill cycle. This may result in a higher or lower bill amount on my first month’s bill, when compared to my normal bill amount. If I choose to stop or cancel this program, my first bill for my standard bill cycle may be for a longer or shorter billing period. To enroll in FLEXPAY, I understand it is mandatory that I sign up for ABP.

Payment Date

Funds will be taken from the designated bank account on the due date listed on the statement you receive. Payment due dates may vary from billing period to billing period on ABP. Payment due dates will be the 15^th or 30th when enrolled in FLEXPAY, based on your selection. Please note the specific date on each bill received. If you have a current utility bill, please remit your payment by the due date.

Funds Not Available

If the funds are not in the bank account you designated on the due date of your bill the payment will be returned by the bank. Returned bank items are assessed a return payment charge. Multiple returns by the bank will result in cancellation of ABP/FLEXPAY payment program.

Termination/Change

The City of DeLand must receive written notice of termination or bank institution change no later than 10 days prior to the time the bank account will be charged. Every effort will be made to honor requests.

Deposit with City's Automatic Electronic Payment Option

If you have signed up for automatic bank payment for a reduced deposit and choose to remove automatic bank payment before your deposit is refunded to the account for good standing, your account will be billed for the remaining amount of the full deposit.

I agree to have read and understand the Terms and Conditions of the ABP & FLEXPAY program

Utility Billing Account Forms

Please select your billing cycle Value is not selected

Authorization for ABP Standard or ABP FLEXPAY (15 & 30)

I hereby authorize the City of DeLand to automatically initiate debit entries (charges) to my bank account (and for my bank to accept and post such debit entries) indicated below for the payment of utility services rendered by the City of DeLand. This authority is to remain in effect until the City of DeLand has received notification from me of its termination in such a manner as to afford the City of DeLand and the bank a reasonable opportunity to act on it. I have the right to stop payment of charge entries by notifying the City of DeLand in writing. The City of DeLand must receive this written notice no later than 10 days prior to the time the bank account will be charged in order to make any changes to this authorization.

Attach a copy of a voided check from your CHECKING account or a deposit slip from your SAVINGS account

I understand by choosing to participate in FLEXPAY 15, or FLEXPAY 30 my first bill may be for a longer or shorter billing period since my utility account will be placed in a different bill cycle. This may result in a higher or lower bill amount on my first month’s bill, when compared to my normal bill amount. If I choose to stop or cancel this program, my first bill for my standard bill cycle may be for a longer or shorter billing period.

Ask about adding a $1.00 monthly credit incentive to your utility account. When you sign up for ABP in addition to eBill, you will receive a total of $2.00 per month credit incentive which is applied to your utility account.

CONTINUE TO PAY AS NORMAL UNTIL YOUR BILL INDICATES “BANK DRAFT”

Copy of Voided check from your CHECKING account or deposit slip from your SAVINGS account Please attach only PDFs

Signature

Utility Billing Account Forms

E-Billing Options

Add E-Billing

Change Email for E-Billing

Remove E-Billing

No Change/Not Authorize

Please enter email address on file:

Please enter new email address:

Authorization for Electronic Bill (e-Bill)

Request to Add, Change or Remove

Please complete and return form if you wish to sign up, change or remove Electronic Bill (e-BILL). Please be sure to include your email address below. Every month you will receive an email with an attachment of your utility bill.

Authorization to Add, Change or Remove e-Bill

This authorization is to remain in effect until the City of DeLand has received notification from me of its termination in such a manner as to afford the City of DeLand a reasonable opportunity to act on it. The City of DeLand must receive this notice no later than 10 days prior to the time the utility bill will be generated in order to make any changes in the mailing process.

I hereby authorize the City of DeLand to automatically send my monthly utility bill to my designated email address. I understand that by adding my email address below, I will no longer receive a paper bill in the mail. I understand I will receive a $1.00 credit incentive per month, as long as I receive my monthly utility bill via email.

I hereby authorize the City of DeLand to automatically send my monthly utility bill to my revised designated email address. I understand that by adding my new email address below, I will continue to receive my bill by e-Bill. I understand I will continue to receive a $1.00 credit incentive per month, as long as I receive my monthly utility bill via email.

I hereby authorize the City of DeLand to remove my email address for e-Bill and send my paper monthly utility bill in the mail. I understand I will no longer receive a $1.00 credit incentive per month by cancelling this service. In addition, if I have chosen to participate in ABP or FLEXPAY I will no longer receive any additional incentives per month by canceling this service

Signature

Your session has timed out.

Click here to access the application.

Utility Billing Account Forms

CITY OF DELAND UTILITY ACCOUNT APPLICATION/CHANGE FORM

New Account