New Service Application

Applications submitted after 4 PM will be processed on the next business day. Please see our list of office hours and holidays that may affect your application.

Contract for Service – Existing Home or Business

Utilities Commission, City of New Smyrna Beach, Florida |
Phone (386) 427-1361 | Fax (386) 424-2713 | www.ucnsb.org

Today's date:

Month

Day

Year

Requested Service Start Date: (required)

Month

Day

Year

Applicant Information

Name of Applicant: (required)

Applicant is: (required)

Owner

Tenant

Date of Birth: (required)

Month

Day

Year

Previous service with Utilities CommissionC? (required)

Yes

Previous Address (no P.O. Box):

Street Address:

City:

State:

Zip code:

Email Address: (required)

Phone:

Home Phone: (required)

Cell Phone:

Work Phone:

Co-Applicant Information

Name of Co-Applicant:

Co-Applicant is:

Owner

Tenant

Date of Birth:

Month

Day

Year

Social Security #:

Previous service with UC?

Yes

Previous Address (no P.O. Box):

Street Address:

City:

State:

Zip code:

Email Address:

Phone

Home Phone:

Cell Phone:

Work Phone:

Requested Service Address:

Street Address: (required)

City: (required)

State: (required)

Zip code: (required)

Service Address Type: (required)

Business

Residence

Mailing Address Information: (required)

My mailing address is the same as my requested service address.

My mailing address is different from my requested service address. (Enter mailing address below.)

Bill Mailing Address:

Street Address:

City:

State:

Zip code:

This is a rental property. Upon my request, I authorize UCNSB to turn on service in my name between tenants without making additional application.

Yes, I authorize UCNSB to turn on service in my name between tenants without making additional application.

Documentation

Upload photo copies of driver’s license or other official state identification and proof of ownership, lease agreement or Notarized Account Representative Affidavit here.

Applicant Identification

Files must be less than 20 MB.
Allowed file types: gif jpg jpeg png pdf.

Proof of Ownership or Lease

Files must be less than 20 MB.
Allowed file types: gif jpg jpeg png pdf.

Co-Applicant Identification

Files must be less than 20 MB.
Allowed file types: gif jpg jpeg png pdf.

Customer Verification

IF APPLICABLE, RESIDENTIAL HOUSEHOLD AFFIDAVIT: This is to certify that until the undersigned notifies UCNSB in writing, the electrical service provided to the above referenced account is exempt from the Florida Sales Tax for the following reasons: (1) the electrical service provided to this account will be used exclusively to service a residential household and the meter will not service any commercial or business activities. Commercial or business activities include but are not limited to, rental operations that cater primarily to transient guests (hotel, motels and room rentals), the provisions of day care facilities, and the performance of any activity that is not residential in nature. (2) The electrical service provided to this account will be used exclusively to serve common areas of residential housing complexes, and the meter will not serve any commercial or business activities such as vending machines, coin operated laundry facilities, sewage/lift station equipment, or any activity that is not residential in nature. (3) The electric service provided to this account will be used exclusively to serve a residential model home. The meter will not serve any commercial activity such as a sales or business office, or any activity that is not residential in nature.

Customer Verification (initial): (required)

Initial connect charge is $35 (reconnect fee is $50) and will be billed on the first billing statement to the customer. Photo copies of driver’s license or other official state identification and proof of ownership, lease agreement or Notarized Account Representative Affidavit are required.

I hereby make application to the Utilities Commission, City of New Smyrna Beach (UCNSB), Florida for utility service and upon approval of this application, agree to abide by all UCNSB resolutions, tariffs, policies, procedures, rules and standards, and acknowledge and agree this contract is made subject to the provisions of UCNSB’s Rates, Charges and Fees and Services Policies and Customer Information Manual, the latter of which I have been provided, and incorporates such manual as part of this contract as it exists at the time of this contract and may be amended as per the last paragraph of said manual. I also acknowledge and agree that the undersigned, as a UCNSB customer, shall be liable for all applicable sales tax and agree that I will be personally responsible for the payment of deposit and/or utility bills rendered under this account.

Name of Applicant Signifying Agreement: (required)

Name of Co-Applicant Signifying Agreement:

Leave this field blank

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For questions or to report problems: (386) 427-1361

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New Service Application

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