HomeMy WebLinkAboutNEW CUSTOMER APPLICATIONnLe
r/ WATER
SEWER
METER SZ.
COMM
RES
M/F
IRR
$ 0M SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
DQ METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR, REV
LATERAL
TOTAL
ST LUCIE COUNTY WATER,& SEWER_ DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAM
ACCT. # _ 33 � �P
SERVICE ADDRESS 535
SUBDIVISIO
BILLING AD
f
U )
LOT BLOCK__1____
EMAIL ADDRESS:
PHONE #75 Q - O VMOVE 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.
aX APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UMXry SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER Vrff YI'Y 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
OFFICE USE ONLY
DATE RECEIVED � � d 1
CASH CHECK #-� 2-7 o3_ RECEIVED BY