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Wastewater Service Application

  1. TownLogo_2x3_v2

  2. Wastewater Service Application

  3. Town of Thompson's Station 1550 Thompson's Station Rd W Thompson's Station, TN 37179

  4. 615-794-4333 billing@thompsons-station.com

  5. Customer Information

  6. Type of building*

  7. Are you the Owner or Renter*

  8. Billing Name & Address

    (If different from service address)

  9. Landlord Information (if you are a Renter, please fill this in)

  10. WASTEWATER FEES ARE BILLED MONTHLY AND PAYMENTS ARE DUE TO THE 25TH OF EACH MONTH (STATEMENT RECEIVED OR NOT RECEIVED)

  11. DEPOSIT IS NON-REFUNDABLE ($75.00 residential, $150.00 commercial)

  12. UNPAID BALANCES WILL BE SUBJECT TO A LATE FEE OF 10% OF THE BALANCE DUE

  13. ANY UNPAID BALANCE WILL BE SUBJECT TO WATER SHUT-OFF UNTIL PAID IN FULL

  14. 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.

  15. I UNDERSTAND THAT A $35.00 RETURNED ITEM FEE WILL BE ADDED TO MY ACCOUNT FOR ANY TRANSACTION REFUSED BY MY FINANCIAL INSTITUTION.

  16. I HAVE READ AND HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT.*

  17. Leave This Blank:

  18. This field is not part of the form submission.