HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESJi LUWt UIJU IItS DEP
2300 VIRGI� E
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FORT PIERCE , 382
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07;11j2018
CREDIT CARD
1ITIES: PO BOX728 .T PIERCE FL34982
2:51:19
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MC SALE
Card
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XXXX1iXXXXXXXI414
SEQ #:
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Batch:
Dr
929
s
ICE
I
Approval Code:
Entry Method:
003796 A -.
Manual i
�
=
Mode
�� LOT BLOCK
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Tax Amount:
Onlone:
$0.00 ��
Ir
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Gust Code:
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Avs Code:
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Card Code:
NNN
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SALE AMOUNT 116,25
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iy request and autforizes the Utility to render water and/or sewage disposal
!
SCANNEDdes
descnbed above in accordance with.the Utilities present or future rates,
rwhich by reference are made a part of this contract Applicant agrees to pay
By
�or such services �n accordance with{the established rules and regulations,
ARE
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SITS NON NEGQTIABLE OR TRANSFERABLE
CUSTOMER
SOCIAL SEC/`
SIGNATURE
Y
NAME OF SP`SPOUSE
SOCIAL SECT
I OFFICE USE ONLY
I DATE RECEIVED %II I Q CASH L :RECEIVED
:
WATER' Comm
SEWER RES
METER SZ. M/F
IRR
$ SECURITY bEP
SERVICE FEE
'SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC1WATER
FPUA CFC,
CFC/SEWER
GUAR. REV.
LATERAL
'A O'd
$ TOTAL
CUSTOMER
qTr.M ATT TA
NAME OF SPOUSE
ST. LUCIE COUNT'
NAME j
ACCT. #
SERVICE ADDRESS
- P.O.
)(A
f
SUBDIVISION —UlbUXSIWU LOT b—'� BLOCK
2
BILLINGADDFss //-51�
19
PHONE MOVE IN/CLOSING DA'TE,.
This application h
. ercby request. and autborizies the Utility to render water and/cir sewage disposal
services to the premises desc;hbed 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
the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
DATE RECEIVED47
CASH
OFFICE USE ONLY
RECEIVED BYZ,,441-(