HomeMy WebLinkAboutSLC Utilities Payment SlipST CIE UTILITIES DEP
2300 VIRGINA AVE
FORT PIERCE, FL 34982
(4/012021
09:41:16,
MID: XXXXXXX,'(X 2488 TID:
XXXXX501
CREDIT CARD
VISA SALE
Card XXXXXXXXXXXX7926
SEQ ti:
4
Barth N:
1609
INVOICE
4
fq proval Code:
01499G
B-1try Method:
Manual
Mode:
Online
1'ax Arnouit:
- $0.00
Card Code:
M
SALE AMOUNT $521,25
I agree to pay above total amount
according to card issuer agreement.
lerchant agreement If Credit Voucher)
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ACCY. #
SERVICE
; 4906 BUCHANAN
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SUBDIVISION IRE — — - LOT 7,839- — BLOCK 2
BILLING ADDRESSn � � ` I cV
EMAI[. DDRESS;
3 PHONE # / MOVE IN/CLOSING DA
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CO) This application hereby request and authorizes the Utility to render water and/or sewage disposal
'a services to the premises described above in accordance with the Utilities present or future rates, rules
P and regulations, which by reference are made a part of this contract. Applicant agrees to pay Utility
promptly for such services in accordance with,the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIALSEC/FED 1D
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
awi;- V i 5a_ CHK # RECEIVED BY
;arges beginning for water and/ or wastewater on the day the meter and/or service is installed by
r a customer connects to or starts utilizing the meter and/or service.
on of service, I will be billed and am obligated to pay the Base Facility Charges.