BUSINESS APPLICATION – TOWN OF BRASELTON UTILITIES DEPT.
4986 Highway 53,  P.O. Box 306,   Braselton, Ga. 30517   Phone: 706-654-3915   Fax: 706-654-9100
 

 Services Applied For (check all that apply): 

Water

Sewer Reuse  

A deposit is required for service. Deposit amounts can be paid via cash, check, or money order or can be included on the first month’s bill. The Town reserves the right to collect any outstanding utility bills or business taxes/licenses owed to the Town by the applicant and payment of the deposit before the new service is established. Applicants with Town accounts in good standing may have their existing deposit(s) transferred.


 

  Inside Town Limits Outside Town Limits
Meter Size Water Sewer Reuse Water Sewer
3/4" $65.00 $70.00 $35.00 $75.00 N/A
1" $120.00 $140.00 N/A $130.00 N/A
Deposits for larger meters shall be the Public Works Director’s estimate of 2 months of actual projected usage for that particular customer.


Three (3) days notice must be given in writing or in person to connect or disconnect service. Application must be filled out completely, accurately and legibly (including property owner information) in order to establish your account and you must be at least 18 years old. You may be required to provide a copy of your lease agreement, purchase agreement or picture ID. Customers must insure all inside plumbing is shut off. Any damages as a result of open faucets or leaks inside the building are the customer’s responsibility. Any applications faxed after 5PM will be processed the next business day. (Weekends and Holidays are not included.) Only authorized personnel are allowed inside the meter box. If someone other than a city employee damages the meter box or its contents, the customer of record will be responsible. Any maintenance, turn ons, turn offs, or rereads will be done per customer request or during regular maintenance and reading schedules. Charges for rereads and meter testing may apply.


Business Name
Type of Business
(retail, restaurant, bank, etc)
Tax Identification #
Contact Person
Contact Business Phone # (xxx) xxx-xxxx
Contact Emergency Phone # (xxx) xxx-xxxx
 
Service Address
City
State
Zip Code
Occupancy Date mm/dd/yyyy
Date You Desire Water Service mm/dd/yyyy
 
Mailing Address (if different)
City
State
Zip Code
 
Owner of Company or Manager in Charge
Address
City
State
Zip Code
Date of Birth mm/dd/yyyy
Social Security # xxx-xx-xxxx
Driver's License Number
State
Email Address xxx@xxx.xxx
 
Property Owner Name (if other than applicant)
Property Owner Address
City
State
Zip

Have you ever had services with the Town of Braselton Before? Yes   No
If yes, when and where?
 
Do you need a disconnect at a current address? Yes   No
Date of disconnect
Address (if different from above)
City
State
Zip Code

In applying for service, I verify that to the best of my knowledge the above information is correct. My signature indicates I have read all the above information.  I understand that providing false information may result in the rejection of my application or disconnection of services at a later date.


Signature: 

Date: 

mm/dd/yyyy

 

Note: An application for reuse water service requires the execution of an additional agreement, the Reuse Water Use Agreement, which must be printed, completed and faxed to 706-654-9100 or mailed to 4986 Highway 53, P.O. Box 306, Braselton, Ga. 30517. A link to this .pdf is located on the Public Works page.