Fillable Tenant Change Request Form - Bonney Lake, Washington printable pdf download

9002 Main Street East

PO Box 7380, Bonney Lake, WA 98391

Phone: (253) 447-4317 Fax: (253) 862-8538

Website:

TENANT CHANGE REQUEST

DATE: _____________________

UTILITY ACCOUNT # ________________________________

OWNER’S NAME: ________________________________________ HOME PHONE # _______________________

CELL PHONE # ___________________________________ WORK PHONE # ______________________________

SERVICE LOCATION: __________________________________________________________________________

EFFECTIVE DATE: ________________________

OWNER’S MAILING ADDRESS: _______________________________________

_______________________________________

The information below will be verified anytime the customer requests access to utility account information. Please list

information for each legal property owner on the utility account.

PROPERTY OWNER’S DRIVERS LICENSE #________________________________ STATE: _______

I understand if I put the billing in the name of my tenant and if the tenant fails to pay the utility bill I will be

responsible for all charges including but not limited to utility bill, penalties and any other utility billing fees.

It is illegal for the City to participate in any eviction process. Therefore, water service will not be

terminated per the owner’s request if a residence is known to be occupied. It is the responsibility of the

owner to provide written notification of any changes in residency status or billing information.

As owner of the property in reference above, I understand that I will be billed for utility services supplied

to this location and herein request that a copy of the billing statements and all notices for utility services

be mailed to the TENANT at the service address. Tenants will not receive prorated statements. I

agree to a $45.00 alternate address fee which will be charged to my account for this duplicate billing

service. I also understand that each time there is a change of tenants, I must renew this agreement. I

understand that this service may be stopped at anytime upon my written request.

(Circle one) I am requesting to start / stop Duplicate Billing Service for the address above.

***Utility account must have a zero balance before a new tenant will be added***

TENANT NAME: _____________________________________TENANT PHONE # _________________________

TENANT CELL # ____________________________________ TENANT WORK # __________________________

: ____________________________________________________________

TENANT MAILING ADDRESS

OWNER’S SIGNATURE: ____________________________________________ DATE: _____________________

For Office Use

Identity Verified By: _____________________ Date Posted: ___________________ Initial: _________

Updated Feb. 2016

Tenant Change Request Form - Bonney Lake, Washington