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R` COMM ST`LUCIE COUNTX UTILITIES P.O BOX 728,FT PIERCE;FL34982.:
SEWER RES hI f 7 � ta
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NAME%
METER
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ACCT.#
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$ s SECURITY DEP SERVI.CE ADDRESS
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SERVICE FEE
SAME DAY FEE
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OVERTIME-FEE
METER.INSTALL` BILLINGADDRESS
CFC/WATER
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FPUA CFC j
PHONE#.. 772 �'�` ,""•&. ' MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. This application hereby request and authorizes ahe Utility to render water and/or sewage disposal
,i services to the premises described above in accordance with'the Utilities present or future rates,
LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay .
the Utility promptly for such services in accordance with the established rules and regulations.'
$ TOTAL CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SEC/
SIGNATURE - � ' FED ID
NAME OF SPOUSE �1 SPOUSE SOCIAL SEC.
OFFICE USE ONLY
:, 1 DATE RECEIVED�V'CASH CHK RECEIVED BY y