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ST-LUCIE
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P 0 BOX 728,.FT PIERCE,FL 3x982
ST LUCIE UTILITIES EP NAME
2300 VIS'
LINA 3 �
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St. L FORT PIERCE,FL 34982 I ACCT
02-05 02/05/2016
10;02;03 �2. 1Ci
CREDIT CARD sERvicE ADDREss
VISA SALE
DUROL
5712 Card# UWM=4555 E LOT BLOCK
FORT Chip Card; VISA CREDIT I susDrvlslorr
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FL 3= :AID; A0000000031010; ` '
ATC; L BIL LINGADDRESS'
0003
Amoy . TC: E32D2EF004CCA246
Amol SEQ#: 4 - - —�-T—
Bdteh#; 328MOVE-1N/CLOSING DATE
INVOICE 4
,hai Approval Code;
Enhy Method; 005811 This apphcatiop hereby request and authorizes the Utility to render water and/or sewage"A"ispose
Chip Read [ services to the+premises described above in accordance with theUtiliries present or future rate
iha Mode; Issuer i rules and regulations,which byeference are made a part of this contract AppLcaiit agrees o pa
the utility promptly for such"services ii accordance with the.established rules a_nd regulation
t CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE
JS( SALE AMOUNT $521,25
4 30CIAL SEC/
FE '11-D
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CUSTOMER COPY
SPOUSE SOCIAL SEC 1.
FFI E USE;ONLY
tj CEIVED BY
CHK#