TOWN OF CLAYTON Utilities & Billing/Customer Service utilities@townofclaytonnc.org

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TOWN OF CLAYTON Utilities & Billing/Customer Service utilities@townofclaytonnc.org NEW SERVICE CHECKLIST ALL DOCUMENTS ARE REQUIRED before your account can be established. You can bring your documents to our office located in The Clayton Center at 111 E. Second Street, faxed to 919-553-0719, or emailed to utilities@townofclaytonnc.org. They can also be mailed to Utilities & Billing, P.O. Box 879, Clayton, NC 27528. Failure to provide all of these documents can delay connection of services. TENANT/RENTER Completed Town of Clayton Utility Service Application State or Federal Issued Photo ID Copy of signed lease Deposit in the form of cash, check, money order, or credit/debit card (waived with proof of satisfactory payment history from previous utility provider) Voided check or a letter from your bank with your routing and account number, if you are going to participate in bank draft ALL TOWN OF CLAYTON ACCOUNTS MUST BE CURRENT BEFORE SERVICE CAN BE SET UP PROPERTY OWNER Town of Clayton Utility Service Application Proof of Purchase (one of the following) Signed HUD-1 Settlement Statement Recorded Deed Offer to Purchase or Contract of Sale State or Federal Issued Photo ID Deposit in the form of cash, check, money order, or credit/debit card (waived with proof of satisfactory payment history from previous utility provider) Voided check or a letter from your bank with your routing and account number, if you are going to participate in bank draft

TOWN OF CLAYTON Utilities & Billing/ Customer Service P.O. Box 879, Clayton, NC 27528 Phone: 919-553-5002 utilties@townofclaytonnc.org YOUR UTILITIES & BILLING AT A GLANCE Payment options Bank Draft: FREE! Never have a late fee or penalty again! Online: Click here to pay by credit or debit card online at TownofClaytonNC.org. Save time, save gas, save a stamp! There is a small convenience fee of $3.95 for this service. Mail: Slip your payment in the envelope provided and send to P.O. Box 63024, Charlotte, NC 28263-3024 Outdoor Drop Box: Want to drop off a payment 24/7 from the convenience of your car? Use our drive-up drop box located in the Horne Street parking lot of The Clayton Center. Use the box for check and money orders, but not cash. You'll find it on the Fayetteville Street side of the parking lot, and it's super shiny so it's hard to miss! Pay in Person: We take cash, check or money order at our Utilities & Billing Department, located on the second floor of The Clayton Center, 111 East 2nd Street. We're open during regular business hours, weekdays from 8 a.m. to 5 p.m. During that same time frame, you can drop check or money order payments off in a box located on the 2nd Street side of the building. Look for the drop box in the space between the two sets of glass double doors. Due, Penalties, Non Payment Collection Your due date is printed on your bill. A 5% penalty is added to your bill the day after your due date if not paid on the due date. A $25.00 disconnection penalty is added to your bill if ANY balance has not been paid in full 7 days after your due date. If the Town is unable to collect from a closed past due account within 60 days, we will use an outside collection company. Please be advised that these companies report to the 3 credit reporting agencies. If the Town must pursue collections for an unpaid balance, we can collect from your NC State Income Tax Refund. Returned Checks/Drafts The Town s returned check/draft fee is $20.00. Customer Service will contact you by phone or email. Please update your contact information with any changes. If we cannot contact you by phone we will put an orange door hanger on your door to notify you of the returned item. You will have 48 hours to pay the returned amount plus the $20.00 fee. If you do not make a payment within the 48 hours, your services will be disconnected. A utility account will be placed in a cash only status with a 2nd returned draft/check. Accepted paymets for "cash only" accounts are cash, money order/cashier s check/debit card/credit card for a minimum of one year. A 2nd returned draft will get you removed from the bank draft plan and you could be required to pay an additional deposit, due immediately. A returned check for a deposit results in an immediate disconnection without benefit of prior notifiation.

service to be activated: Name of Customer: Service Address: Rent Own Mailing Address: of Birth: Social Security Number: Driver s License #: *Email: Phone number: (alternate): Co-Applicant: Phone number: Social Security Number: Driver s License # of Birth: *Email: Have you or any other occupant at this address ever had a utility account with the Town? Yes, please state address: No, please initial: Who was your previous utility provider? Did you leave owing a balance to this utility provider and if so, how much? *Email addresses are used to send reminders about payment being due. You acknowledge that by not providing the Town with an email address, your bill will serve as your final notice. This means you will not recieve further information regarding late payments or disconnections. You certify that you are eighteen years of age or older, that the above information is accurate, and that you will be responsible for payment of the entire bill upon termination of service. Additionally, if the Town determines that you or any other occupant at this address owes past due balances to the Town, you/we will be responsible for payment of those balances and any associated fees. You have had an opportunity to review a copy of the Town s cut-off policy and are subject to the Town s Utility Policy as currently in effect. The account is subject to immediate disconnection without notice if the deposit and connect fee is returned for insufficient funds or if the Town discovers delinquent past due balances from prior accounts. You further agree, in order for us to service your account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or emails, using any email address you provide us. Methods of contact may include using pre-recorded or artificial voice messages and/or the use of an automatic dialing device as, applicable. I/We have read this disclosure and agree that the town of Clayton may contact me/us as described above. Signature Signature TOWN OF CLAYTON Utilities & Billing/Customer Servicee Utility Service Application YES - I want free e-billing! NO - Mail my bill to my home. SS# Verified Photo ID Verified P.O. BOX 879 * CLAYTON * NORTH CAROLINA * 27528 * (919) 553-5002 * FAX (919) 553-0719 Lease/HUD Deposit Paid Work Orders Billing Items NP Billing Items Customer Checklist Entered (date/initials)

Residential Utility Deposit Information Account # Account # A. Account History Waiver: Customer must provide at time of establishing service: proof of social security number, valid photo ID and a letter of credit from current utility provider demonstrating good payment history defined as: no late payments, no returned checks, no returned drafts and no disconnects for nonpayment within the immediate preceding 12 months. B. Participating Deposit: Customer must provide at time of establishing service: proof of social security number, valid photo ID and deposit (listed below); the customer MUST enroll in Bank Draft. Deposit Schedule Electric $150 Water $50 Sewer $50 Irrigation (if applicable) $50 TOTAL $50-300 C. Non-Participating Deposit: Customer must provide at time of establishing service: proof of social security number, valid photo ID and deposit (listed below); the customer may decline participation in Bank Draft. Deposit Schedule Electric $300 Water $50 Sewer $50 Irrigation (if applicable) $50 TOTAL $50-450 Premium Deposit Schedule *Billed over 12 month period* Electric $100 Water $10 Sewer $10 Irrigation (if applicable) $10 The deposit shall only be refunded, net of any outstanding bill, at the time of account closing. D. High Risk Deposit: Customer must provide at time of establishing service: valid photo ID and deposit (listed below); the customer declines to provide proof of social security number. Deposit Schedule Electric $800 Water $120 Sewer $120 Irrigation (if applicable) $120 TOTAL $120-1160 TOWN OF CLAYTON Utilities & Billing/ Customer Service P.O. Box 879, Clayton, NC 27528 Phone: 919-553-5002 After 6 months of successful bank drafts, the customer s deposit will be applied to their account. If any unsuccessful bank drafts occur within the first 6 months of service, the deposit will not be applied; it will then be subject to review at the account s 1 year anniversary date. PLUS Participation in Bank Draft and/or Budget Bill will not have any impact on the deposit schedule for customers in the High Risk category. The deposit shall only be refunded, net of any outstanding bill, at the time of account closing.. I,, have read the above information and elect deposit option. Customer s Printed Name I understand that I may be required to pay an additional higher deposit, establish a new deposit, or reestablish a deposit after my original deposit has been refunded if any or all of the following conditions apply to my account: disconnection for nonpayment, failure to honor payment arrangement, returned checks/drafts, meter tampering, and/or falsification of information provided on service application. Under these terms, the deposit must be paid immediately or immediate disconnection may occur. Customer s Signature Town of Clayton Witness Signature Service Address NOTE: Customers with unpaid delinquent balances with other units of government shall be required to bring all delinquent accounts current before services can be established with the Town of Clayton, and they may be subject to a higher deposit.

BANK DRAFT AUTHORIZATION The Town of Clayton offers customers the convenience of paying monthly utility bills via draft from a checking account. Participants will continue to receive their monthly bill and will have their account drafted on a scheduled due date. If you would like to take advantage of this service, please complete this application and return it to the Customer Service Department. We will process your request as quickly as possible. New Bank Draft Authorization TOWN OF CLAYTON Utilities & Billing/ Customer Service P.O. Box 879, Clayton, NC 27528 Phone: 919-553-5002 Account # Change in Account Number or Bank Cycle 1: DATE TO DRAFT ACCOUNT 8 th 15 th 22 nd Cycle 2: DATE TO DRAFT ACCOUNT 15 th 22 nd 29 th Cycle 3: DATE TO DRAFT ACCOUNT 15 th 22 nd 29 th Cycle 4: DATE TO DRAFT ACCOUNT 8 th 22 nd 29 th Name of Customer: Service Address: Phone #: (home) (alternate) Please attach a voided check here. ** Deposit slips cannot be processed ** I hereby authorize the Town of Clayton to draft my utility payments and initiate credit entries or such adjusting entries, either Debits or Credits, which are necessary for corrections or adjustments from the account and bank I have indicated above. This authorization is to remain in full force and effect until the Town receives a new written agreement from me. I understand that cancellation of bank draft will require a thirty (30) day prior written notice to the Town. I understand that drafts not honored by my financial institution shall be treated in the same manner as a returned check, and shall be subject to all applicable fees and charges. I further understand that as is the policy with returned checks, if I have two returned drafts within a twelve month period, I shall be removed from draft payment, and shall be required to pay in cash or certified check for a period of twelve months. I hereby certify that I will notify the Customer Service department immediately of any changes in my depository relationship with my financial institution that shall affect this draft agreement. I am also aware Customer Service will need 30 days notice if I should need to change my draft date. Authorizing Signature P.O. BOX 879 * CLAYTON * NORTH CAROLINA * 27528 * (919) 553-5002 * FAX (919) 553-0719

TOWN OF CLAYTON Utilities & Billing/Customer Service P.O. Box 879, Clayton, NC 27528 Phone: 919-553-5002 Account # BUDGET BILLING APPLICATION Name of Customer: Service Address: Phone #: (home) (alternate) I desire to have the Town of Clayton bill my account in equal monthly amounts for the purpose of budgeting my expenses. My signature below signifies that I understand and agree to the terms of the policy shown on this application. Budget Bill Payment Plan AL The purpose of this Budget Bill plan is to offer customers an option to pay a flat amount per month for their utility service account. The amount is based on an average of the customer s last twelve months of utility bills. The customer is responsible for paying at least this budget bill amount by the due date each month for twelve months. Due dates will remain the same as the normal billing cycle and all penalty and cutoff policies will remain in effect. IO N On the twelfth month of budget bill payments, the customer s account will either have a balance or a credit. In the event of a remaining balance, the customer s budget bill amount will be increased for the next twelve months to include the remaining balance. In the event of a credit, the customer s budget bill amount will be decreased for the next twelve months to incorporate the credit. O PT In the event one of the following conditions apply to an account, the customer will be required to bring their account to a zero balance and will no longer be eligible for the plan: disconnection for nonpayment, returned checks/drafts, meter tampering, and/or falsification of information provided on service application. If the customer is delinquent three (3) or more times in a twelve month period, they will be removed from the budget bill program. No penalties will accrue, regardless of account balance, if payment is received by the due date. Any customer who had any delinquencies or bad checks in the previous twelve months is not eligible for this plan. The Town reserves the right to request a payment adjustment conference with the customer between anniversary dates if it appears that the amount billed and the amount paid will vary by a substantial amount. Authorizing Signature P.O. BOX 879 * CLAYTON * NORTH CAROLINA * 27528 * (919) 553-5002 * FAX (919) 553-0719

TOWN OF CLAYTON Utilities & Billing/Customer Service P.O. Box 879, Clayton, NC 27528 Phone: 919-553-5002 Load Management Application I choose to OPT OUT of the Load Management Program Signature: Account Number: Customer Name: Service Address: Mailing Address: Phone: E-Mail: Owner Agreement: I request that Load Management controls be installed on my home for the purpose of controlling the following ELECTRIC appliances: Water Heater AC Compressor (25% Program = 15min/hr) Heat Pump / Heat Strips AC Compressor (50% Program = 30 min/hr) Please note: GAS appliances are not eligible for the Load Management Program Through participation in the program, I will receive related credits on my monthly utility bill: Electric Water Heater: Heat Pump/Heat Strips: AC Compressor 25%: AC Compressor 50%: $5.00/month (January thru December) $12.00/month (December thru March) $6.00/month (June thru September) $10.00/month (June thru September) I agree for the Load Management Switch to remain connected for a minimum of one year from date of installation. If controls are disconnected or removed prior to the one-year period, customer will forfeit credits and the Town will require customer to refund credits earned. Signature: TOC Witness: : : Landlord/Tenant Agreement: I give the Town of Clayton permission to install Load Management equipment on my property for the purpose of controlling the operation of my electric devices during peak hours. Landlord Name: Mailing Address: Phone: E-Mail: Landlord Signature: Witness Signature: : : P.O. Box 879 * CLAYTON * NORTH CAROLINA * 27528 * (919)553-1530 Fax: 919-553-1541

TOWN OF CLAYTON Utilities & Billing/ Customer Service P.O. Box 879, Clayton, NC 27528 Phone: 919-553-5002 EEOC Data Collection The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the ethnicity, race, and gender of the individual applicants on the basis of visual observation or surname. Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: American Indian/Alaskan Native Asian Black/African American Native Hawaiian/Pacific Islander White Gender: Male Female P.O. BOX 879 * CLAYTON * NORTH CAROLINA * 27528 * (919) 553-5002 * FAX (919) 553-0719