HomeMy WebLinkAboutUtility payemnt slip WATER COMM ST. LUCIE COUNTY UTILITIES - P.O. BOX 728 FT. PIERC FL 34982
SEWER RES NAME t ` l •� �ekV i� L 1
METER SZ. M/F y '
ACCT. # O
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SECURITY DEP SERVICE ADDRESS
SERVICE FEE
SAME DAY FEE �.-
SUBDIVISION LOT BLOCK w2
OVERTIME FEE
\'` METER INSTALL. BILLING ADDRESS
CFC/WATER
FPUA CFC MOVE IN/CLOSING DATE
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CFC/SEWER
This application hereby request and authorizeXhe Utility to render water and/or sewage disposal
GUAR. REV. 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.
q. TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
CUSTOMER
SIGNATURE - t FED ID -
NAME OF SPOUSE l �l it ( � h 1 SPOUSE SOCIAL SEC.
OFFICE USE ONLN
v SH CH. # RECEIVED BY
DATE RECEIVED /