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This form is used for adding or removing Co-Applicants to new or existing City of Gastonia/Two Rivers Utilities accounts.

ON MOBILE DEVICES AND TABLETS, THIS APPLICATION WORKS BEST IF THE DEVICE IS TURNED IN A LANDSCAPE POSITION.

Your Name

Effective Date

New Service Location Address

Please upload a new copy of lease, new utility verification form or other proof that you are no longer living at the service location above.

Mailing Address:

Identity Information

Below is required information that is pertinent to establishing, or being an authorized user of, a utility account with the City of Gastonia or Two Rivers Utilities.  This information is considered by the City of Gastonia to be confidential and is encrypted to keep it secure and separate from basic account information, which may be placed on public record for the purposes of collecting a debt.  In accordance with the Identity Theft Protection Act, as shown below, it is unlawful to place certain identifiable information on documentation that may be placed on public record.

Providing your Social Security Number (SSN) is not mandatory to have utility service with the City of Gastonia but is required if you want to submit your application securely online and/or be eligible for other services such as online account access and payment arrangements.

If you decide not to provide your SSN, you will need to apply in person with the Customer Service Division located on the first floor of the Garland Business Center, 150 S. York Street, Gastonia NC 28052.

Please upload below a clear image of your U.S. government issued photo identification or completed, signed and notarized Identity Verification Form below.  

Acceptable forms of identification include driver's license, passport, identification card, military ID, permanent resident or resident alien card.  Employer work badges or personal photos cannot be accepted.

If you need to access the Identity Verification Form to print and complete, click here:  

There is a 250MB limit on each attachment.

Upload Photo ID or Identity Verification Form Here

IDENTITY THEFT PROTECTION ACT

NCGS §132-1.10(d)

No person preparing or filing a document to be recorded or filed in the official records of the register of deeds, the Department of the Secretary of State, or of the courts that may include any person’s social security, employer taxpayer identification, driver’s license, state identification, passport, checking account, savings account, credit card, or debit card number, or personal identification (PIN) code or passwords in that document, unless otherwise expressly required by law or court order, adopted by the State Registrar on records of vital event, or redacted...

Any person who violates this subsection shall be guilty of an infraction, punishable by a fine not to exceed five hundred dollars ($500.00) for each violation.

The entire Identity Theft Protection Act can be found at

https://ncleg.net/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_75/Article_2A.pdf

Notice

Online Utility Exchange provides City of Gastonia credit and past utility information to determine the amount of the deposit required. Deposit amount depends on information furnished by Online Utility Exchange and can be waived if Online Utility Exchange qualifies the rating.  If a deposit is required, this amount must be paid in full before utility service is supplied to the location.  This deposit is non-transferable, non-interest bearing, and will not be considered as part payment of any bill where service is continued.  Proof of ownership or a copy of your lease must also be provided at the time of application.

The City of Gastonia asks that individuals provide your Social Security number and business entities provide your federal tax identification number as a part of your application for utility service.  The request for an individual customer’s Social Security number or an entity’s Federal Taxpayer Identification Number is authorized by Section 105A-3(c) of the North Carolina General Statutes.  Individual Social Security numbers and business federal tax identification numbers collected by the City’s Billing and Customer Service offices may be used to check credit worthiness for purposes of establishing the amount of required deposit, to confirm identity of the customer, by means of matching the number with information found in the City’s databases, or to determine whether the customer qualifies for additional services such as payment arrangements or online account access.   They may be released to the State of North Carolina for use in the Debt Setoff program or other governmental agencies or their agents.  It may also be released to private debt collection agencies for the purpose of collecting debts owed to the City.  Access to personal information such as identification, Social Security number and bank account information are only accessible by authorized City personnel for purposes outlined above and general account maintenance.

If any individual decides not to provide their Social Security number as part of your application, you will still be provided utility services.  However, you will be required to apply in person, pay a deposit for utility services and certain services offered as a courtesy by the City of Gastonia, such as payment arrangements and online services, may not be available to you.

I hereby make application for utility services with the City of Gastonia/Two Rivers Utilities at the service location indicated above and certify that the information provided is true and correct to the best of my knowledge.  In requesting utility service, I accept full responsibility for any charges, fees, penalties or other obligations incurred by this account, regardless of service location.  I also agree to abide by all present and future rules and regulations of the City of Gastonia that may apply to my utility service. 

Click here for additional rules and regulations in Gastonia City Code Chapter 14 - Utilities

Customer Signature

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