APPLICATION FORR WATER SERVICE
FOR OFFICE USE ONLY
THE CITY OF WATERVILLE
PLEASE PRINT
ACCOUNT NUMBER____________________________________
NAME_______________________________________________
RECEIPT NUMBER________________________________________
ADDRESS_____________________________________________
DEPOSIT________ DATE______
APPLICANT IS OWNER___ TENANT___AGENT___
MOVE IN DATE____________MOVE OUT DATE_____________
NUMBER OF PERSONS IN HOUSEHOLD_____________________
FORWARDING ADDRESS______________________________
APPLICANTS DATE OF BIRTH______________________________
______________________________________________________
REFUND CHK#_________AMT___________DATE__________
REQUIRED SIGNATURE OF PROPERTY OWNER:
APPROVED BY:__________________________________________
I understand that, as a property owner of the above property, I will be
ACCT CREDIT AMT________________DATE________________
held liable for all delinquencies and agree to make payment to the City
of Waterville for any amounts outstanding attributable to any tenant at
APPROVED BY:__________________________________________
the above property, and that water service to the above location will be
discontinued if payment is not received in the manner prescribed by the
Water Department.
BILLING ADDRESS IF DIFFERENT
STREET______________________________________________
APPLICANTS SIGNATURE________________________________
ZIP CODE_____________________________________________
PHONE NUMBER______________________________________
DATE________________________________________________
WATER DEPOSIT REFUND POLICY
®
Water Deposits will be reviewed on a monthly basis. All deposits that are eligible for refund, pursuant to Sec on 931.02(d) of the
Waterville Code of Ordinances, will then be processed and refunded.
Sec on 931.02 APPLICATIONS AND DEPOSITS FOR SERVICE
(d) Deposit; refunds. Any water customer of the Municipality
who has a two-year con nuous and uninterrupted record
of prompt payment of all water bills may be en tled to a refund
of such deposit.
(Ord. 19-76, passed 8/23/76; Am. Ord. 16-77, passed 10/24/77; Am. Ord. 16-92, passed 8/24/92)
I have read and understand the above policy.
_______________________________________________________
______________________________
Signature
Date