Property Management Application

Service Information

Service Address

Effective Date

Property Management Information

Company Name

Company Taxpayer Identification Number

Company Contact Name

Company Phone Number

Company Email Address

Owners Information

Owners Name

Owner Phone Number

Owner E-mail Address

Mailing Information (If Different From Service Address)

Mailing Street Address or PO Box

Mailing City, State, Zip

Previous Service Address (If Had District Service Before)

Pervious Service Address

Pervious Service City, State, Zip

Preauthorized Payments

Would like to signup for Preauthorized Payments ?

Yes

Routing Number

Account Number

Disclaimer As the management company representing and responsible for the real property listed above, we understand our agency is responsible for any unpaid debts that may accrue through the use of the District water consumed on the property. We acknowledge and agree that a lien may be placed on the property should these debts remain unpaid. We are aware that if a delinquency occurs on one account, all accounts held are subject to disconnection. We are aware that the owner will be notified may a lien be placed on the property. We are aware that at the appropriate time, it is my responsibility to contact the District to close my account.

Applicant Name

Applicant Phone Number

Applicant Signature

Date Signed