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Last Name, First Name, Middle Name
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If you choose to give your Social Security Number, it may be used to collect any unpaid debts to the Town. We will also use your Social Security Number to check credit worthiness and determine if a security deposit is required to set up your account. If a valid Social Security Number is not disclosed, the required deposit may be a higher amount. For security purposes, a customer service assistant will contact you by phone to request a Tax I.D. or Social Security Number. A deposit of $200 is required unless the account is in the name of an individual.
I understand by clicking "I Agree", I certify the above information is correct. By clicking "I Agree" this acts as your signature.
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