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City of Panama City, FL.

info@pcgov.org

Panama City, FL, 32402, US

850-872-3000

Form Section 1

City of Panama City

Online Utility Activation Application

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Type of Service
Application for Service at:
Requested Activation Date
Date Picker

PERSON LIABLE FOR PAYMENT

Applicant Date of Birth
Employer
Previous Business Account Address
Bill Delivery Address:
Additional Address
Nearest Relative Not Living With You
Relative Address
Is There Other Person(s) That Can Act For You?
Authorized Person Date of Birth
Is there another person you would like to list?
2nd Person Date of Birth
Is there a Landlord?
Landlord Full Address
Related to Landlord?

If you are completing this application from a smartphone or tablet, snap a picture of your Govt. issued picture I.D. along with the cover page of your lease and attach to the application in the fields below. Most all file formats are accepted (PDF, JPG, PNG TIFF etc).

Upload Copy of Photo ID

You have not uploaded a file. Please upload a file to continue.

Copy of Lease/Agreement

You have not uploaded a file. Please upload a file to continue.

BY SIGNING BELOW YOU AGREE TO THE FOLLOWING

The undersigned applicant for residential water/sewer/garbage service states that the information provided in this application for city utilities is true and accurate to the best of applicant's knowledge. Applicant also understands that all charges are due as billed and accepts total responsibility for payment of all charges incurred for the services provided, including reasonable attorney's fees and costs incurred for collection of the unpaid balance.

Furthermore, the undersigned applicant consents that water services provided at the location listed may be turned on without applicant or applicant's representatives present. Applicant further agrees to hold the City of Panama City and its employees HARMLESS should the property, building(s) or premises incur damage as a result of water connection.

Sign Here
Receipt
You will be provided with a Receipt upon submission.