HomeMy WebLinkAboutWater & Sewer New Customer ApplicationWATER
IC_ SEWER
METER SZ.
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NEW CUSTOMER APPLICATION
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SAME DAY FEE
OVERTIME FEE
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NAME
ACCT. # -- a 170
SERVICE ADDRESS___ Y
SUBDIVISION LOT < BLOCK 3
BILLING
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EMAILADDRE�SS:
PHONE # �t� J 0 �`7 7� MOVE IN/CLOSING DATE
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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 UTIIM SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTEUTY 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 l CASH CH CKK #D��G��`o��
RECEIVED 8Y I " &bA