Hydrant Account Application

Hydrant Account Process

Following this page is a one page Bulk Water Agreement and a one page Hydrant Account Application. If requesting bulk water service through one of the Town’s hydrants, please first review the Bulk Water Agreement—this is a sample sheet to show you exactly what kind of charges to expect in renting hydrant equipment from the Town. If, after taking these expenses into consideration, you would like to receive bulk water service from the town, please fill out all information on the Hydrant Account Application.

After filling out your application, please either fax it to the number below or have it delivered to: Town of Cary Collections Division, 316 N Academy St, Cary NC 27513. Typically, the Town of Cary can have Hydrant Applications processed and approved in minutes, as long as your financial institution cooperates with our verification process. I will call your bank to verify the applicant has an active account with them, and have found that if the applicant will call ahead to let their bank know that I will be calling them, they are more willing to release this info.

Also, if returning your application by fax, please give me a call so I can process it immediately!

Thanks!

C. Eric Schwarzweller

Collections Account Representative

Town of Cary

P: 919-319-4552

F: 919-388-1130

BULK WATER AGREEMENT (FOR INFORMATIONAL PURPOSES ONLY)

Bulk Water Technician

Date/Time

Service Address

Customer Information

Company Name

Address

Billing Address (if different)

Phone

Credit Status: ' Finance 319-4552

Equipment

Rate

Total

___ Meter/Backflow Preventer

$20.00/day (each)

___ 1.5” hose (50’ section)

$3.00/day (each)

___ 2.5” hose (50’ section)

$3.00/day (each)

___ 1.5” nozzle

$4.00/day (each)

___ Adapter

$4.00/day (each)

___ Wrench

$4.00/day (each)

Date Removed/Checked:

Time:

Finish Reading:

Gallons Used

Date Installed/Checked:

Time:

Start Reading:

$6.38 per 1,000 gallons (.00638) x Total Gallons Used

Setup/Relocation Fee ($40.00 per setup/relocation)

Lost/Damaged Equipment Fees

Total Due

Lost/Damaged Equipment Fees

Initial if OK when:
Item	Delivered	Picked Up
A. Meter Register
B. Gate Valve Handle
C. Gate Valve
D. NST Bushing
E. Meter Handle
F. Inlet Coupling

Cost of new meter if lost or stolen is $748.00 and $336.00 for backflow preventer. Prices subject to change without notice. Meter transactions will be conducted Monday thru Friday, 8 a.m. until 5 p.m.

I understand that if this meter is used for irrigation purposes the water service will be terminated.

I hereby certify that the information listed above is correct to the best of my knowledge. The above listed company will take responsibility for any and all damages caused by our usage to either the equipment or the Town of Cary’s water system.

Checked out by: Print Name___________________________________ Signature_______________________________

Signed in by: Print Name___________________________________ Signature__________________________________

Revenue Collector TOWN OF CARY Remit To:

316 North Academy Street North Carolina Collections Division

Cary, N.C. 27511 P.O. Box 8049

PH: (919) 319-4552 F: (919) 388-1130 Cary, N.C. 27512

APPLICATION FOR CREDIT

Mailing Address

Business Location

TOC Privilege License No.:

BUSINESS OR PERSONAL INFORMATION
If proprietor list your name and home address. If partnership list names and home addresses of all partners. If corporation list name, home address and titles of officers.
Name:	Address:
Name:	Address:
Name:	Address:
Name:	Address:
State Sales Tax Number:
Federal ID Number:
Name-Number of A/P contact:

VENDOR REFERENCES

Vendor Name:	Phone:
Address:
Vendor Name:	Phone:
Address:
Vendor Address:	Phone:
Address:

BANK REFERENCES

Bank Name: Phone:

Address:

Type of Account: Account Number:

Applicant understands payment is due in full thirty (30) days from date of invoice. Applicant also understands that finance charges will

apply if the balance due is unpaid one month from the invoice date. The finance charge is computed by a “Periodic Rate” of 2/3 of one percent per month, which is an annual percentage rate of 9%.

Applicant understands that in the event that legal action must be instituted to collect this account, Town of Cary will be entitled to recover from applicant any and all costs of collection, including reasonable attorney’s fees.

Applicant states that he has read and answered the questions contained on this application for credit and that the information supplied herein is true and accurate to the best of his knowledge and that he is authorized by the applicant to sign on the applicant’s behalf.

________ _______________________ ___________________________

Company Name Date

(Applicant)

________________________________ ___________________________

Signature of Authorized Representative Title