AgreementAgreementI have read and understand that by completing this form and signing below, I agree to the following.Please check agreement to each statement.Falsification of this application may result in immediate disconnection. *Service Requests will not be processed on weekends or holidays. *If a tenant fails to apply for service, the property owner is responsible for all utility charges incurred. *A deposit of $200.00 per dwelling unit is required for all residential utility accounts. Applicants for service at a commercial property must contact customer service for the required deposit amount to activate an account. *A one-time administrative fee in the amount of $30.00 will be assessed on your first bill. *To resume or start service, all customer balances must be paid in full. New service for a tenant will not be processed if the landlord/owner has an unresolved account balance. *Unpaid owner balances may result in a lien on the property. *I acknowledge and agree that the City reserves the right to transfer any amounts due and owing arising from my previous/closed account to an existing/new account belonging to me. *I understand that payments returned for insufficient funds (NSF) may result in immediate disconnection without notice. *Delinquent accounts will bear a penalty of 5% until the account is paid in full. *Meter/meter box must always be accessible to utilities personnel for inspection, testing, and maintenance. *After Hours service requests are subject to a premium service charge. *Tampering with a City Water Meter is prohibited by Ordinance and may result in fees up to the full cost of replacement & repair. *The City of Gulfport is not responsible for damages or involuntary water usage caused by open, leaking, or missing fixtures. To prevent water damage, verify all water faucets are turned off before the desired connection date. Service may not be connected if water is actively running at the property when we attempt to activate service. *I understand that in order to disconnect services, I must contact City Hall and provide my correct information as well as my forwarding information to close my utility account. Documentation to verify occupant change may be required. *ApplicationApplicant Name *Identification Type *State Issued IDDriver's LicensePassportMilitary IDStreet Address *Please enter a valid Gulfport, Florida address.Apartment, suite, etcCityState/Province *State must be FloridaZIP / Postal Code *Desired Connection Date *Service Type *ResidentialCommercialHydrant MeterAccount Type *OwnerTenantBusiness Tax Receipt #Landlord's Name *Additional Adult OccupantsNamePhoneContact InformationMailing Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint HelenaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. MartinSt. Pierre & MiquelonSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Virgin IslandsUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweBest Contact Number *Is this number, capable of Receiving Official City Text Notifications? *YesNoEmail Address *Enroll in E-billing? *YesNoHave you had utility service with us in the past? *YesNoIf yes, please list your previous addressRequired DocumentsLease or Proof of Ownership *Recorded Deed or Signed Settlement StatementChoose FileNo file chosenDelete uploaded fileDriver's license or Tax ID#/EIN *Choose FileNo file chosenDelete uploaded fileSignatureBy signing below (submitting electronically), I affirm that the information provided is true and complete to the best of my knowledge. I understand my electronic submittal has the same legal effect as a handwritten signature.E-SignatureStart signing your signature hereYour browser does not support e-Signature field.Date *Submit