HomeMy WebLinkAboutUtility Receipt ST LUCIE I CEP
2300 VIRGINA AVE
om FORT PIERCE,FL 34982
09141 2021 13:24:18
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m }IU; XXXXXXVXXXX488 TIU: XXXXX501
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o CREDIT CARD
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VISA SALE
x i;�r XKXXXXXXXXXX9509
SEQ 4: 11
Ekitd) 1724
INVOICE 11
a 4iproval Code: 025420
Entry Mediod: Manual
z Mode: Onffne
Card Code: M
T
z SALE AMOUNT � 21.25
I agree to pay A)OVe totdl MOLInt
according to card usurer agreement.
Y (Merchant agreement ff Credit VoLKher)
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MERCHANT COPY
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WATER coMm ST. I.. QE!CaUNTY i- TILITIES-�.� .0 B:aX 2a ._.FT, PIFRCE,rFL 34982
SEWER' ICES NAME � l"Oen
METERSZ... M/F ACI.�! ( I ! f7A,3
IRA
$ . D ' SECURITY DEP SERVICE.AUDRESS e 2rAnnaah
S°ERt/IcE FEi; &de �Q(� �Gl S � pw 3M �--
SAME DAYTEE ,
SUBDIVISION � . LOT "'ice► BLO�KT
OVERTIME:FEE
11 -87
MI_•TER-INSTAL
BIL-tJNG d1DDRESS 1
GFC/11IIATER EMAIL ADDRESS; � � .
FPUA GFC ,�: .
PHOK-W 1 '` - f� iWtSVE.IN/CLOSING SATE
CFC/SEINER .
GUAR. REV, This a.pli.cation hereby request and authorizes the Utility to render: water and/or sewage disposal
services#o.the p:rerriises%ie. Gribe above:ln at-corVance*With the,Utilit'tes-pre5entor future-rati4s;
LATERAL males-and regulations,which by reference,are.made.a part of this contract.AppJicarit.agrees to.pay
$ ( TOTAL Utility-promptly far such services.in accordance vuith:the-established r fes and:regulations..
CUSTOMERS.DEPOSITS-ARE NON NEGOTIABLE:01 TRANSFER;AB4E.
CUSTOMER
SIGNATURE SOCIAL SEC/PER ID.
NAME OF SPOUSE SPOUSE.SOCIAL SEC-
OFFICE USE ONLY
,DATE RECEIVED / `7 ` ( CASH RECEIVED 8YA61l1`-