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SECURITY DEP
SERVICE FEE
SAMEDAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
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TOTAL
SERVICE ADDRESS
PHONE # I,VJ — h �`j yf MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to reader water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
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.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE ORTRANSFERABLE.
CUSTOM • n
SIGNAT
NAME OF SPOUSE
SOCIAL SEC/
FED ID t�
SPOUSE SOCIAL SEC.
DATE RECEIVEDi
�// CASH �7 OFFICE USE ONLY Cure 9