HomeMy WebLinkAboutUtilities receipt - Water�ATM
COMM
SEWER
METER SZ
RES
MIF
IRR
$
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
j
METERINSTALL.
CFC(WATER
FPUA CFC
CFC/SE WER
GUAR. REV.
LATERAL
TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
NAME
ACCT. # , S
SERVICE ADDRESS
ar a- a. i ar+Rt.jr' FL 34V
(
G 6A
SUBDIVISION LOT --= BLOCK JD
BILLING ADDRESS 3WU
1. l 3Y:;�
PHONE #_. MOVE IN/CLOSING DATE -
This application hereby request and authorises the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
'ales and regulations, which by reference are made a part of this contract- Applicant agrees to pay
he Utility promptly for such services in accordance with the established rules and regulations.
.'USTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID�,�(� R_
SPOUSE SOCIAL SEC.
�) OFFICE USE ONLY
DATE RECEIVED CASH CHK # `3 4 RECEIVED BY