HomeMy WebLinkAboutUtility Company ApprovalWATER COMM
SEWER RES
METER SZ. MfF
IRR
$ : Q SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
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GUAR. REV.
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4 t TONAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
ACOT. # dO
SERVICE ADDRESS
'i /'AJn`laln `T
349!W
SUBDIVISION %J-11 l / LOT <3_�.BLOCK
BILLING ADDRESS
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4070
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Utility to ender ter and/or sewage disposal
This appli o Y 4u
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 accordaPoe with the established rules and regulations.
CUSTOZv M DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ 822641841
FED ID
SPOUSE SOCIAL SEC
t?FFiCI~ USE ONLYDATE RECEIVED I ' �+� CASH _ L # RECEIVED BY JaiLu&
T Vdv— ._-- ----- ........_._
ST LUCIE UTILITIES DEP
0 2300 VIRGINA AVE
FORT PIERCE, R. 34982
12111/2020
M 14:46:25
v K-'D: X=)=488 TID: =501
X
0
lu CREDIT CARD
w
0 VISA SALE
X Card 4 W)W=5350
IN #: 21
Etch #: 1534
INVOICE
> 21
41proval Code- 034625
x Enlry Method:
Manual
Online
Tax Amount:
400
Ass Code:
NYZ
Code:
0 CA M
z
M
SATE AMOUNT $1934.25
z
total amount
I agree to pay Ove tO
X a accordhg to card issuer agreement.
0 (Plerftit agreewit if Credit Voucher)
M
0
X X
MERCHANT COPY
0
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