New Tenant/Lessee Form Online

New Account Tenant/Lessee Form

Upon connection of utility service, you hereby agree to hold the TOS and its authorized representatives harmless for any and all liability of property damage caused to your residence or business, as a result of the activation of utility connection.

The Customer shall pay an administration fee as described by ordinance.
The Customer shall install and maintain at his own expense a cut-off valve, a pressure regulator when necessary, and a service line which shall begin at the meter and extend to the dwelling and other portion of premises. Location to be determined by TOS Water Operator.

For Sewer connections the customer shall install and maintain at his own expense a lateral line and backflow preventer when necessary from the sewer main and extend to the dwelling and other portion of premises according to the specifications as directed by the TOS Sewer Operator.

The Customer hereby acknowledges that there may be times when TOS is unable to furnish services and said customer hereby acknowledges that the TOS shall have no liability for its failure to furnish such service.
Customer shall pay for such services at such rates, time, and place as shall be determined by TOS.

TOS is not responsible for mail delivery, check-in transit, and/or checks lost in transit. Failure to receive a bill is no excuse for nonpayment. Amount due must be paid by the due date shown on the face of the bill or your account will be assessed a late penalty. You will have 30 days after the due date to pay the full amount. Original amount due plus late penalty before disconnection. If you do not pay the full amount due before that 30th day, your service will be subject to disconnection. Should you wish to appeal notice prior to disconnect, immediately contact this office and you will be given a hearing. Failure to contact this office for an appeal prior to disconnect will be considered a waiver for the hearing.

If the request for service includes newly constructed installation, all rules for installation must be adhered to by Federal, State, and local governing laws. Failure to do so may result in service interruption until time property brought into compliance.

I am aware that I am responsible for paying for any water, sewage, fire protection and sanitation charges at this address, if it is in my name.  I am aware that it is my responsibility to inform the Town of Sellersburg Utility Billing Office if I plan to move out of this address and to give them my forwarding address.  I am aware I cannot open another account with the Town of Sellersburg Utility Billing Office if I owe a balance on any account in my name.  I understand if my bill is not paid on the due date (15^th of each month), I will be charged a late penalty, and water service is subject to being disconnected.  A re-connect charge & over 60-day late penalty will also be charged if my water is disconnected due to non-payment of a bill.