HomeMy WebLinkAboututility receiptK WATER COMM
SEWER RES
METER SZ, M/F
IRR
$ a SECURITY DEP
SERVICE FEE
SAME DAY FEE
�j`'T�j OVERTZE FEE
�j30. oo METERINSTALL.
6. CFC/WATER
r� _ A FPUCFC
Zt 01 � OO p CFC/SEWER
p�tS6, -{, �ilc} �t GUAR. REV.
T
�y ATER AL
$ — _U TOTAL
CUSTOMER
NAME
WATER
SEWER
METER SZ.
COMM
M/F
AME DAY FEE
OVERTIME FEE
J Q METERINSTAL
CiCf _ CFC/WATER
r�l FPUACFC
�lG.�m oL GUAR. REV.
LATERAL
r I
TOTAL
ACCT. #
SERVICE ADDRESS
J
BILLINGADDRESS aCjhjnfN
PHONE #l"'U Q %q - a3I S ' MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage dispose
services to the premises described above in accordance with the Utilities present or future rates
rules and regulations, which by reference are made apart of this contract Applicant agrees to pa}
the Utility promptly for such services in accordance with the established rules and regulations
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
soelAL SEC/
�U _ 3�: f /.�
FED ID
SPOUSE SOCIALSEC.
S
SERVICEADDRESS
SUBDIVISION �trrJ �'flJ./1-Q-� LOT t !i% BLOCK
3Gol 0�la,Tlilrvl i31Jd
bn mead-i
S Iv20VE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or fuhue rates,
rules and regulations, whichby 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 OR TRANSFERABLE.
SOCIAL SEC/
FED E)
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