HomeMy WebLinkAboutUTILITY REC 66WATER
COMM
1� SEWER_
RES
METER SZ,
M/F
00 IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV,
LATERAL
O TOTAL
CUSTOMER
(AJ
SIGNATURE
NAME OF SPOUSE
OUTM, S P.O. BOX 728. FT. PIERC'
NAME
ACCT, #
SERVICE ADDRESSOS
C 1 S
SUBDIVISION f • AA � LOT BLOCK
BILLING DRESS
PHONE # (-34] 1 t 3 3— ! I I t d— MOVE 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 future rates,
rules and regulations, which by reference are made apart 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 FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH QNK-# M RECEIVED BY