OLDHAM COUNTY WATER DISTRICT
LANDLORD AGREEMENT FOR CONTINUED WATER SERVICE
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Landlord Name
*
Email
*
example@example.com
Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Signature
*
PO BOX 51 Buckner, Kentucky 40010 502-222-1690 FAX - 502-222-1694
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