Rent In Advance to Water Authority

Rent In Advance to Water Authority
This authority is between…

Pacific Link Housing
Suite G02, 280 Mann Street, Gosford NSW 2250
PO Box 1888 Gosford NSW 2250
Phone: 4324 7617

And....
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number
Please enter a valid phone number.
Email*
I give Pacific Link Housing permission to pay any non-rent account charges from my rent payments in advance, until the account is paid in full, keeping my rent two (2) weeks in advance at all times.

Please indicate the extra amount you agree to pay each fortnight towards your non-rent account.

This will apply to current and future water accounts. $

I am aware that these payments are in addition to my fortnightly rent payments and it is my responsibility to notify my banking institution or Centrelink etc. of the extra amounts to be added to my fortnightly rent payments.
Print Name*
Please sign where indicated below

Clear
Date Signed*

MonthDayYear
Date
Should be Empty: