Transfer of Water Service Application

Account Name *

First Name Last Name

Account Number

Current Service Address *

Street Address

Street Address Line 2

Date to Disconnect Service at Current Service Address *

Month Day Year

New Service Address *

Street Address

Date to Start Service at New Service Address

Month Day Year

Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

E-mail *

Is Service Address is RENTED or LEASED, please complete the following section.
A COPY of your lease will be required prior to start of new service.

Name of Rental Agency or Landlord

Rental Agency or Landlord Phone Number

Lease Start Date

Month Day Year

Lease End Date

Month Day Year

By sending this agreement, the customer agrees to the following:

The Company shall not be responsible for the maintenance and operation of the customer's pipes and facilities. The customer agrees not to utilize any appliance or device which is not properly constructed, controlled and protected or which may adversely affect the water service; the Company reserves the right to discontinue or withhold water service to such apparatus or device.
The Company may refuse to discontinue water service rendered under application made by any member or agent of a household, organization, or business for any reason contained in Rule 25-30.320, Florida Administration Code. Any unauthorized connections to the customer's water service shall be subject to immediate discontinuance without notice, in accordance with Rule 25-30.320, Florida Administrative Code.
The customer agrees to abide by all existing Company rules and regulations as constrained in the tariff.
Bills for water service will be rendered monthly as stated in the rate schedule. Bills must be paid within 20 days of mailing bills. If payment is not made after 5 working days written notice, service may be discontinued.
When a customer wishes to terminate service on any premises where water and/or wastewater service is supplied by the Company, the Company may require (oral, written) notice within 5 days prior to the date customer desires to terminate service.

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