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2. Landlord First Name*
3. Landlord Last Name*
5. Mailing Address*
7. City*
8. State*
9. Zip Code*
11. Date of Birth*
12. Driver's License Number or Tax ID*
14. Upload a copy of your driver's license or a copy of your Tax ID number/W-9*
16. Primary Phone Number*
20. Property Management Company
22. Tax ID Number
23. Primary Phone Number
25. Mailing Address (if different than service address)
27. City
28. State
29. Zip Code
33. Service Address(s)
35. Service Start Date
    Service Start Date
37. Address
38. Apt./Unit/Ste.
40. City
41. State
42. Zip Code
46. Service Start Date
    Service Start Date
48. Address
49. Apt./Unit/Ste.
51. City
52. State
53. Zip Code
57. Service Start Date
    Service Start Date
59. Address
60. Apt./Unit/Ste.
62. City
63. State
64. Zip Code
68. Email *
70. Would you like the service transferred back to the landlord account when the tenant requests to close their account?*

    1. Yes
    2. No
72. Would you like the water turned off at the curb stop when a tenant requests to close their account? This will require an appointment with Water Customer Service.*

    1. Yes
    2. No
74. Would you like to receive your bill via email? (A paper copy will not be mailed)*

    1. Yes
    2. No
76. Would you like to receive landlord notifications via email? *

    1. Yes
    2. No
78. Acknowledgement

    Submittal of this application indicates agreement to abide by the rules of the utility, paying bills rendered and providing the City access to the city meters, wires and pipes at reasonable times as provided by law.  

    Note: Personal Information and phone numbers are for customer security and City use only.

80. I understand and acknowledge the statement above.*

    Type first and last name to sign digitally.

Leave This Blank:


82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit

* indicates a required field