Water Service Transfer Application - Rental Property Owner

Application Date*
MM slash DD slash YYYY
Requested Transfer Date*
MM slash DD slash YYYY
Primary Account Holder*
First Last
Is There a Secondary Account Holder?*
Secondary Account Holder*
First Last
Employer*
Service Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Same as Mailing Address?*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Driver's License #*
Social Security #*
Former Tenant Name*
First Last
Former Tenant Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Tenant Phone*
Tenant Email*
By clicking submit, I certify that the above statement is true.
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