Application Type - Select One (Terms Below) * Residential Commercial/Homebased Commercial Exempt Residential - The electric service to this account will be used exclusively to serve a residential household. No commercial activities, including short term rental activity will be served by this meter. Short term rental activity is defined as periods of less than six months. Commercial/Homebased - The electrical services to this account will be used exclusively for commercial activities and will be subject to sales tax by the Florida Department of Revenue. Commercial Exempt - The electric service to this account will be used exclusively to serve a business entity that has been exempted from sales tax by the Florida Department of Revenue. Certificate number and expiration noted below. Certificate Number * Certificate Expiration * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202420252026202720282029203020312032203320342035203620372038203920402041204220432044 The undersigned understands that if such purchases of electric power or energy do not qualify for exemption, the undersigned will be subject to sales and use tax, interest, penalties by the Florida State Department of Revenue, and that when any person shall fraudulently, for the purpose of evading tax, issue to a vendor or to any agent of the State a Certificate or statement in writing which he claims exemption from the sales tax, such person, in penalty of 100 percent of the tax, shall be liable for fine and punishment as provided by law for a conviction of a misdemeanor of the second degree, as provided in FL 775.002, FL 775.003. FL 775.004. Applicant Information Service Start Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20242025202620272028202920302031203220332034 Location * Billing Preference * - Select -E-BillingPrinted Bill Primary Applicant Primary Applicant Name * Mailing Address * Home Phone * Cell Phone Email * Sex * - Select -FemaleMale Driver's License * Current Employer * Do you have a co-applicant? * - Select -NoYes Co-Applicant Co-Applicant's Name * Co-Applicant's Driver's License * Co-Applicant's Employer * Business Request Business Name * Federal ID * Principal Officer(s) * Home Phone * Cell Phone Driver's License Terms & Acknowledgement I understand and agree to pay all services that are available at this address. * ** All applicants must acknowledge receipt of a copy of our service guidelines to proceed. Please access/download/print the document here: Utilities Customer Service Guide ** By initialing this I agree to all the terms and Ordinances by the City of Wauchula and that I have received the Utility Service Guide (linked above). * I agree, in order for the City of Wauchula to service my account or to collect any amounts I may owe, they may contact me by telephone at any telephone number associated with my account, including wireless telephone numbers, which could result in charges to me. The City and/or any agency hired by the City may also contact me by sending text messages or emails, using any email address I provide them. Methods of contact may include using pre-recorded or artificial voice messages and/or the use of an automatic dialing device, as applicable.I have read this disclosure and agree that The City of Wauchula may contact me as described above. Signature * Co-Applicant Signature * Name of Organization * Date * Month MonthApr Day Day23 Year Year2024 Leave this field blank
