Are you a: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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As of November 2, 2020, the system development fee application and review process has been incorporated into Leland's new online permitting and inspections system called Evolve, a web-based platform that will streamline the permitting and inspections process for customers and staff.

Access Evolve

Please select one of the following options: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you are the tenant, please provide rental agreement and list the name of the owner/property management company and their contact information.

Residential account holders may complete this form after one (1) year of uninterrupted service or upon the disconnection of service, whichever is earlier, to receive the utility deposit refund.

You must have a good payment history (i.e. no returned checks or disconnects for non-payment, and with only two late penalties) within the past twelve (12) months.

Residential account holders may complete this form to submit a forwarding address for final bill/return of deposit. Disconnection of services will occur when proof of ownership is submitted (closing disclosure or settlement statement). Final readings will be taken on metered services within five business days of the termination effective date. A final bill will be mailed to the account holder with the words "FINAL BILL"

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Do you have a closing disclosure or settlement statement? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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(Certificate of Occupancy is not acceptable documentation)

If you do not have a closing disclosure or settlement statement, we suggest you wait until the house has gone to closing and you have the appropriate paperwork in order to complete this application.

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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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(If only last 4 digits are provided, an additional utility deposit is required.

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(based upon availability)

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If there are more than one applicant, both applicants' names must be on the lease or purchase agreement

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(In accordance with 15A NCAC 02T .0114, each bedroom or any other room or addition that can reasonably be expected to function as a bedroom shall be considered a bedroom.)

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Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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When submitting the residential water and sewer application, please also submit a copy of the building plans.

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(Be as descriptive as possible, including proposed usage, occupants, seats, and rooms as applicable.)

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*In completing this application and in accordance with 15A NCAC 02T .0114, each bedroom or any other room or addition that can reasonably be expected to function as a bedroom shall be considered a bedroom.

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Commercial Irrigation & Installation Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Water System Development Fees

Commercial  Based on Occupancy

Sewer System Development Fees

Commercial  Based on Occupancy

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Residential Water & Installation Fee** {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Will the irrigation be transferred to an HOA upon sale of the property? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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**The Town of Leland will install the meter and meter box. The applicant must install all backflow prevention devices - dual check and backflow preventer in accordance with Town standards.

Once application has been reviewed, you will be invoiced with total fees due.

**DO NOT REMIT PAYMENT AT THIS TIME!**

CERTIFICATION: I certify that I am authorized to make this application and the information provided is correct to the best of my knowledge. I understand this account will be my responsibility until a new applicant makes an application with the Town of Leland.

Paperless Bill (Go Green) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Security Deposit: $200.00

(It is required that everyone pays a deposit regardless of credit history. Deposits are returned after 1 year of timely payments).

*There is an additional $100 utility deposit required from applicants that choose not to provide a social security number. 

The social security number could be used as a personal identifier for internal records, fraud prevention and collection purposes through North Carolina local government debt setoff clearing house.

Service can be refused for prior utility delinquencies. Code of Ordinance can be found on our website at www.townofleland.com (these are subject to change at any time, I understand that I will be held accountable to these new changes.)

I hereby certify that the above information is true to the best of my knowledge.

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(Please note, you will not be prompted to pay a deposit until you receive an account number through email) 

Debit/Credit Card: You will be provided with the account number through email after the application has been processed.

Check: Please make checks payable to "Town of Leland". Checks can be mailed to 102 Town Hall Dr, Leland, NC 28451.

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Type of Meter {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Town Meter Pricing

3/4" Meter

Deposit $200.00

Base Fee $5.00 per Day

All Usage (0-6,000) $4.00 per 1,000

All Gallons (over 6,000) $5.27 per 1,000

Hookup Fee $50.00

Town Meter Pricing

3" Meter

Deposit $1,000.00

Base Fee $15.00 per Day

All Usage (0-6,000) $6.04 per 1,000

All Gallons (over 6,001) $7.06 per 1,000

Hookup Fee $50.00

Personal Meter Pricing

3/4" Meter

Deposit $200.00

Base Fee $5.00 per Day

All Usage (0-6,000) $4.00 per 1,000

All Gallons (over 6,000) $5.27 per 1,000

Hookup Fee $50.00

Personal Meter Pricing

3" Meter

Deposit $200.00

Base Fee $15.00 per Day

All Usage (0-6,000) $6.04 per 1,000

All Gallons (over 6,001) $7.06 per 1,000

Hookup Fee $50.00

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I authorize the Town of Leland to have my Utility Payment drafted directly from my bank account or other financial institution. I understand that my account will be drafted on the due date indicated on each statement. I also understand that if the draft is rejected because of insufficient funds or other reason, I may be subject to additional fees.

Draft from Checking Account

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Draft from Credit Card

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Example: 1234-5678-1234-5678

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Example: 01/20

Name on Credit Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I authorize that this authorization will be in effect until I notifty Town of Leland in writing that I no longer desire this service, allowing it is reasonable time to act on my notification. I also understand that if corrections in the debit amount are necessary it may involve an adjustment (credit or debit) to my account.

I have the right to stop payment of a debit entry by notifying my financial institution before the account is charged. If an erroneous debit entry is charged against my account, I have the right to have the amount of the entry credited to my account by my financial institution. I agree to give my financial institution a written notice identifying the entry, stating that it is in error, and requesting credit back to my account. I will provide this writtten notice within 15 calendar days following the date on which I was sent a statement of my account or a written notice of such entry, or 45 days after posting, whichever occurs first.

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As of November 2, 2020, the system development fee application and review process has been incorporated into Leland's new online permitting and inspections system called Evolve, a web-based platform that will streamline the permitting and inspections process for customers and staff.

Access Evolve

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If you are the tenant, please provide rental agreement and list the name of the owner/property management company and their contact information.

Residential account holders may complete this form after one (1) year of uninterrupted service or upon the disconnection of service, whichever is earlier, to receive the utility deposit refund.

You must have a good payment history (i.e. no returned checks or disconnects for non-payment, and with only two late penalties) within the past twelve (12) months.

Residential account holders may complete this form to submit a forwarding address for final bill/return of deposit. Disconnection of services will occur when proof of ownership is submitted (closing disclosure or settlement statement). Final readings will be taken on metered services within five business days of the termination effective date. A final bill will be mailed to the account holder with the words "FINAL BILL"

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If you do not have a closing disclosure or settlement statement, we suggest you wait until the house has gone to closing and you have the appropriate paperwork in order to complete this application.

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Social Security # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email for Invoice {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date Needed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Business Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Co - Applicant Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Social Security # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Co - Applicant Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Service Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Forwarding Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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x {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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When submitting the residential water and sewer application, please also submit a copy of the building plans.

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Work Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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*In completing this application and in accordance with 15A NCAC 02T .0114, each bedroom or any other room or addition that can reasonably be expected to function as a bedroom shall be considered a bedroom.

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Commercial Irrigation & Installation Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Water System Development Fees

Commercial  Based on Occupancy

Sewer System Development Fees

Commercial  Based on Occupancy

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Water System Development Fees {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Sewer System Development Fees {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Residential Water & Installation Fee** {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{binding displayValue}
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**The Town of Leland will install the meter and meter box. The applicant must install all backflow prevention devices - dual check and backflow preventer in accordance with Town standards.

Once application has been reviewed, you will be invoiced with total fees due.

**DO NOT REMIT PAYMENT AT THIS TIME!**

CERTIFICATION: I certify that I am authorized to make this application and the information provided is correct to the best of my knowledge. I understand this account will be my responsibility until a new applicant makes an application with the Town of Leland.

Paperless Bill (Go Green) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Security Deposit: $200.00

(It is required that everyone pays a deposit regardless of credit history. Deposits are returned after 1 year of timely payments).

*There is an additional $100 utility deposit required from applicants that choose not to provide a social security number. 

The social security number could be used as a personal identifier for internal records, fraud prevention and collection purposes through North Carolina local government debt setoff clearing house.

Service can be refused for prior utility delinquencies. Code of Ordinance can be found on our website at www.townofleland.com (these are subject to change at any time, I understand that I will be held accountable to these new changes.)

I hereby certify that the above information is true to the best of my knowledge.

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Debit/Credit Card: You will be provided with the account number through email after the application has been processed.

Check: Please make checks payable to "Town of Leland". Checks can be mailed to 102 Town Hall Dr, Leland, NC 28451.

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Type of Meter {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Town Meter Pricing

3/4" Meter

Deposit $200.00

Base Fee $5.00 per Day

All Usage (0-6,000) $4.00 per 1,000

All Gallons (over 6,000) $5.27 per 1,000

Hookup Fee $50.00

Town Meter Pricing

3" Meter

Deposit $1,000.00

Base Fee $15.00 per Day

All Usage (0-6,000) $6.04 per 1,000

All Gallons (over 6,001) $7.06 per 1,000

Hookup Fee $50.00

Personal Meter Pricing

3/4" Meter

Deposit $200.00

Base Fee $5.00 per Day

All Usage (0-6,000) $4.00 per 1,000

All Gallons (over 6,000) $5.27 per 1,000

Hookup Fee $50.00

Personal Meter Pricing

3" Meter

Deposit $200.00

Base Fee $15.00 per Day

All Usage (0-6,000) $6.04 per 1,000

All Gallons (over 6,001) $7.06 per 1,000

Hookup Fee $50.00

Comments: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I authorize the Town of Leland to have my Utility Payment drafted directly from my bank account or other financial institution. I understand that my account will be drafted on the due date indicated on each statement. I also understand that if the draft is rejected because of insufficient funds or other reason, I may be subject to additional fees.

Draft from Checking Account

Financial Institution Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Bank Account Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Bank Transit/Routing Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Draft from Credit Card

Credit Card Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Credit Card Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name on Credit Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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I authorize that this authorization will be in effect until I notifty Town of Leland in writing that I no longer desire this service, allowing it is reasonable time to act on my notification. I also understand that if corrections in the debit amount are necessary it may involve an adjustment (credit or debit) to my account.

I have the right to stop payment of a debit entry by notifying my financial institution before the account is charged. If an erroneous debit entry is charged against my account, I have the right to have the amount of the entry credited to my account by my financial institution. I agree to give my financial institution a written notice identifying the entry, stating that it is in error, and requesting credit back to my account. I will provide this writtten notice within 15 calendar days following the date on which I was sent a statement of my account or a written notice of such entry, or 45 days after posting, whichever occurs first.

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Remove Name On Bill {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Change Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email Address Change {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone Number Change {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Are you a: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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As of November 2, 2020, the system development fee application and review process has been incorporated into Leland's new online permitting and inspections system called Evolve, a web-based platform that will streamline the permitting and inspections process for customers and staff.

Access Evolve

Please select one of the following options: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Are you a {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please select one of the following {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

If you are the tenant, please provide rental agreement and list the name of the owner/property management company and their contact information.

Residential account holders may complete this form after one (1) year of uninterrupted service or upon the disconnection of service, whichever is earlier, to receive the utility deposit refund.

You must have a good payment history (i.e. no returned checks or disconnects for non-payment, and with only two late penalties) within the past twelve (12) months.

Residential account holders may complete this form to submit a forwarding address for final bill/return of deposit. Disconnection of services will occur when proof of ownership is submitted (closing disclosure or settlement statement). Final readings will be taken on metered services within five business days of the termination effective date. A final bill will be mailed to the account holder with the words "FINAL BILL"

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Landlord's Name and Contact Info {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Service Start Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Do you have a closing disclosure or settlement statement? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please upload closing disclosure or settlement statement. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you do not have a closing disclosure or settlement statement, we suggest you wait until the house has gone to closing and you have the appropriate paperwork in order to complete this application.

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Account Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Effective Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Account Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Effective Disconnect Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Social Security # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Social Security # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email for Invoice {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date Needed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Business Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Business Name or First/ Last Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Service Start Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Co - Applicant Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Social Security # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Co - Applicant Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Co - Applicant Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Business Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Service Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Subdivision {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Bedrooms {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Forwarding Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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x {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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When submitting the residential water and sewer application, please also submit a copy of the building plans.

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Type of Facility {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Work Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Bedrooms {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Type of Dwelling {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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*In completing this application and in accordance with 15A NCAC 02T .0114, each bedroom or any other room or addition that can reasonably be expected to function as a bedroom shall be considered a bedroom.

Commercial Water & Installation Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Commercial Irrigation & Installation Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Water System Development Fees

Commercial  Based on Occupancy

Sewer System Development Fees

Commercial  Based on Occupancy

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Water System Development Fees {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Sewer System Development Fees {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Residential Water & Installation Fee** {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Will the irrigation be transferred to an HOA upon sale of the property? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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**The Town of Leland will install the meter and meter box. The applicant must install all backflow prevention devices - dual check and backflow preventer in accordance with Town standards.

Once application has been reviewed, you will be invoiced with total fees due.

**DO NOT REMIT PAYMENT AT THIS TIME!**

CERTIFICATION: I certify that I am authorized to make this application and the information provided is correct to the best of my knowledge. I understand this account will be my responsibility until a new applicant makes an application with the Town of Leland.

Paperless Bill (Go Green) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Security Deposit: $200.00

(It is required that everyone pays a deposit regardless of credit history. Deposits are returned after 1 year of timely payments).

*There is an additional $100 utility deposit required from applicants that choose not to provide a social security number. 

The social security number could be used as a personal identifier for internal records, fraud prevention and collection purposes through North Carolina local government debt setoff clearing house.

Service can be refused for prior utility delinquencies. Code of Ordinance can be found on our website at www.townofleland.com (these are subject to change at any time, I understand that I will be held accountable to these new changes.)

I hereby certify that the above information is true to the best of my knowledge.

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Debit/Credit Card: You will be provided with the account number through email after the application has been processed.

Check: Please make checks payable to "Town of Leland". Checks can be mailed to 102 Town Hall Dr, Leland, NC 28451.

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Type of Meter {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Town Meter Pricing

3/4" Meter

Deposit $200.00

Base Fee $5.00 per Day

All Usage (0-6,000) $4.00 per 1,000

All Gallons (over 6,000) $5.27 per 1,000

Hookup Fee $50.00

Town Meter Pricing

3" Meter

Deposit $1,000.00

Base Fee $15.00 per Day

All Usage (0-6,000) $6.04 per 1,000

All Gallons (over 6,001) $7.06 per 1,000

Hookup Fee $50.00

Personal Meter Pricing

3/4" Meter

Deposit $200.00

Base Fee $5.00 per Day

All Usage (0-6,000) $4.00 per 1,000

All Gallons (over 6,000) $5.27 per 1,000

Hookup Fee $50.00

Personal Meter Pricing

3" Meter

Deposit $200.00

Base Fee $15.00 per Day

All Usage (0-6,000) $6.04 per 1,000

All Gallons (over 6,001) $7.06 per 1,000

Hookup Fee $50.00

Comments: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I authorize the Town of Leland to have my Utility Payment drafted directly from my bank account or other financial institution. I understand that my account will be drafted on the due date indicated on each statement. I also understand that if the draft is rejected because of insufficient funds or other reason, I may be subject to additional fees.

Draft from Checking Account

Financial Institution Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Bank Account Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Bank Transit/Routing Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Draft from Credit Card

Credit Card Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Credit Card Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name on Credit Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I authorize that this authorization will be in effect until I notifty Town of Leland in writing that I no longer desire this service, allowing it is reasonable time to act on my notification. I also understand that if corrections in the debit amount are necessary it may involve an adjustment (credit or debit) to my account.

I have the right to stop payment of a debit entry by notifying my financial institution before the account is charged. If an erroneous debit entry is charged against my account, I have the right to have the amount of the entry credited to my account by my financial institution. I agree to give my financial institution a written notice identifying the entry, stating that it is in error, and requesting credit back to my account. I will provide this writtten notice within 15 calendar days following the date on which I was sent a statement of my account or a written notice of such entry, or 45 days after posting, whichever occurs first.

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Remove Name On Bill {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email Address Change {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone Number Change {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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