HomeMy WebLinkAboutST LUCIE COUNTY UTILITIES WATER COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728 FT.PIERCE FL 34982
SEWER RES NAME
METER SZ. M/F '
ACCT.#
IRR
$ SECURITY DEP SERVICE ADDRESS
SERVICE FEE
SAME DAY FEE
SUBDIVISION LOT BLOCK
OVERTIME FEE
METER INSTALL. BILLING ADDRESS
CFC/WATER
FPUA CFC PHONE# MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. This application hereby request and authorizes the Utility to render water and/or sewage disl
services to the premises described above in accordance with the Utilities present or future r
LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees tc
the Utility promptly for such services in accordance with the established rules and regulat.
$ TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER 4 , i; SOCIAL SEC/
SIGNATURE - FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH "CHK# RECEIVED BY
i.111rt u'1111'11ES DEY
010 A(%'WIIJA AVE
ORT PINCE,FL 34982
f;16,2021 15:20:39
CREDIT CARD
MC SALE
�d XXXXXXXXXXXX3556
l sip Card: Mastercard
'JD: A000000O041010
1EQ x: 16
Satcli ; 1704
INVOICL 16
Tpoval Code. 01697Z
is rb y H&od: Chip Read
11ode- Issuer
'AlF.AMOUNT $521,25
CUSTOMER COPY