HomeMy WebLinkAboutUTILITY RECEIPTE
-TTCIE UTILITIES DEP
2300 VIRGINA AVE _
FORT PIERCE, FL 34982
08,i0912021 11:0823
CREDIT CARD
VISA SALE
Card A
XXXXXXXXXXXX2552
Chip Card:
CHASE VISA
0:
A000000O031010
SEQ d:
8
Batch ti:
1699
INVOICE
8
Rppioval Code:
04694G
Entry Method:
Chip Read
Mode:
Issuer
Tax Amount:
$0.00
SALE AMOUNT $521.25
IM
_E
E
�L
/WATER
CUSTOMER COPY lA CFC
/SEWER
(3UAR. REV
LATERAL
$ TOTAL
ST LUd.E COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME '� C_... Cf ! 1 r. l „� �.". ir.� f / t.� a• � i �' 1M� .,r � ,� L/ C:_.. I-
�' r71.
ACCT. # / / cam!
SERVICE ADDRESS & 0 X l / /)L/io"
i
SUBDIVISION-I=L--` LOT
4
BILLING
EMAIL ADDRESS: / ii V 0 I C & S
BLOCK_
PHONE # " �� �' ` �' f MOVE IN/CLOSING DATE
This application hereby requests 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 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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE. UTILITY SERVICE
F-] APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
n OFFICE USE ONLY
\ f
DATE RECEIVED
f �� CASH C- K`#' RECEIVED BY