HomeMy WebLinkAboutSLC UTILITIES RECEIPT✓ WATER
SEWER
METER SZ.
COMM ST. LUC
fRES NAME
_ M/F
ACCT. #
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
SERVICE ADDRESS
BILLING ADDRESS ,
IN/CLOSING DATE
0
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.
CUSTOMER SOCIALSE
SIGNATURE!tea
NAME OF SPOUSE SPOUSE SOCIAL SEC.
DATE
OFFICE USE ONLY
CASH CHK•# iq/ RECEIVED