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ST LUCIE�TIUTIES DEP ST LUCIE COUNTY_UTILITIES O BOX 728 FT.PIERCE FL 34982
2300 VIRGINA AVE l✓C, �GL��I.
FORT PIERCE,FL 34982 NAME
10%05/2015 13;31;44 ACCT.# �Y
CREDIT CARD
MC SALE50
,SERVICE ADDRESS V � L'` ��tiilj�--•
Card 4OG�O(9485
SEQ#; 21
Batch#; Ir�
INVOICE 246 SUBDIVISION.. i LOT r `� BLOCK
Approval Code; 23 BILLINGADDRESS' �G�2LR
Enby Method: 023672 L.:, `.
Swiped
Mode; Online
SALE AMOU NT PHONE# �� - ��'d l yl U 3 :'MOVE IN/CLOSING DATE
$52 ,25
This application heceby request'and_authorizes the Utility to render water and/or sewage disposal
services toahe premises described:above in accordance with the Utilities present or future rates'
CUSTOMER COPY - �- 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,.estabhshed rules and regulations;
TOTAL CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE. ;.-
CUSTUItifI;K , SOCIAL SEC/
SIGNATURE - ' , FED ID
NAME OF.SPOUSE SPOUSE SOCIAL SEC.
J OFFICE USE ONLY /�
DATB RECEIVED/ ! CASH' C 'RECEIVED B
RECEIVED OCT 0 5.2015