HomeMy WebLinkAboutUTILITIESr 2300 V�DfMA AVE C,�t` ` ' `, ` ` ` c,' } ° l
f� FORT PIE 'L 34982``
1 V17ATER z TY iJ�IIhITIES P O BO S, FT FIERCE; FL 3498Z
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SEWER CREDIT CARDS }ti� k
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SEQ �: 20 ? SS Y 1
Batch; 929 z �k
20 INVOICE
Approval Code; 018740 F t �.• k 1 ", Y f
Entry Method; Manual ` �LS1..:' �Y zs LOT BLOCK
! Mode; _ Online
-I� Tax Amount: $0 OD
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Avs Code; NNN4 } Y
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Card Code; M
MOVE IN/CLOSING BATE
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SALE AMOUNT
I $116 25 { , z
aereby request and authorizes the Utility to render water and/or sewage disposal
remises described above in accordance with the s Ut►hties preent or future rat
es,
I� ons, which by reference aremade a pert oP his contract Apphcant;agrees topay ,.:
x �11y for such servtces'in accordance with the estabhshed rules and regulations
$,, ' I��e � J �, ' -- POSITS; ARE NQN NEGOTIABLE OR TRANSFERABLE + , �,
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SERVICE FEE
SAME DAY FEE
9 OVERTIME FEE
METER INSTALL.
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GUAR. REV.
LATERAL
S MCI. U TOTAL
CUSTOMER
J1V1\1'11 Vl\L'. -
1UNTY UTILITIES - P.O. BOX 728, FT. PIERCE. FL 349E
NAME
ACCT. #
SERVICE ADDRESS
PHONE # 3'
T -U BLOCK
MOVE IN/CLOSING DATE
This application hereby request 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
the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
NAME OF SPOUSE> 'J (/ �QQ SPOUSE SOCIAL SEC.
0
DATE RECEIVED
�. OFFICE USE ONLY
CASH CHK::# �. RECEIVED BY