HomeMy WebLinkAboutNEW CUSTOMER APPLICATIONWATER Comm
SEWER _7"RES
METER SZ. M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
T37"r..DD METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 60g _ TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAM
ACCT. # 15_57`o( — 330 4
SERVICE
SUBDIVISI
BILLING
LOT L4 -3 BLOCK i'
EMAIL ADDRESS:
PHONE A05 ' 7c�/�, 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 TBE UT RY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTUM SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S. PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID --
NAME.OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK#
RECEIVED BY