Wastewater Service Application

2. Town of Thompson's Station

   1550 Thompson's Station Rd W Thompson's Station, TN 37179

3. 
4. Phone: (615) 794-4333 Ext. 4

   Email: newservice@thompsons-station.com

6. Customer Information
7. Type of building*

   1. Residential
   2. Commercial
8. Are you the Owner or Renter*

   1. Owner
   2. Renter
10. Applicant's First Name
11. Applicant's Last Name
12. Service Start Date*
    Service Start Date
14. Service Address*
15. Subdivision
    -- Select One --AllenwoodAvenue DownsBridgemore VillageFields of CanterburyTollgate VillageWhistle StopOther
17. Phone Number*
18. Email Address*
20. Last 4 digits of Social Security #*
21. Date of Birth*
25. Billing Name & Address (if different from service address)
27. First and Last Name
28. Full Billing Address
32. Landlord Information (if you are a Renter, please fill this in)
34. First and Last Name
35. Phone Number
37. Email Address
41. WASTEWATER FEES ARE BILLED MONTHLY AND PAYMENTS ARE DUE TO THE 25TH OF EACH MONTH (STATEMENT RECEIVED OR NOT RECEIVED)
43. DEPOSIT IS NON-REFUNDABLE ($75.00 residential, $150.00 commercial)
45. UNPAID BALANCES WILL BE SUBJECT TO A LATE FEE OF 10% OF THE BALANCE DUE. ANY UNPAID BALANCE WILL BE SUBJECT TO WATER SHUT-OFF UNTIL PAID IN FULL.
49. I HEREBY REQUEST CONNECTION AND BILLING OF WASTEWATER SERVICE AS NOTED IN THIS APPLICATION, TO BE FURNISHED AT THE STANDARD RATES AND UNDER THE TERMS AND CONDITIONS OF THE TOWN OF THOMPSON’S STATION. I AGREE TO PAY ALL CHARGES FOR SERVICE RELATED TO THIS ACCOUNT.
51. I UNDERSTAND THAT A $35.00 RETURNED ITEM FEE WILL BE ADDED TO MY ACCOUNT FOR ANY TRANSACTION REFUSED BY MY FINANCIAL INSTITUTION.
53. I HAVE READ AND HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT.*

    1. I Agree
54. Today's Date*
    Today's Date
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field