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APPLICATION FOR SEWER SERVICE
Property Info:
Property Address: ____________________________________, Arizona City, AZ 85123
Escrow Closing Date: __________________________
Legal Owner Info:
Name(s): ______________________________________________________________________
Mailing Address: _______________________________________________________________
_______________________________________________________________
(City) (State) (Zip)
Phone: ____________________ Email (Optional) __________________________________________________________
Social Security # (Last four (4) only) ___________ or Business EIN ________________________
______________________________//________________________//____________________
Relative Not Living With You Relationship Phone # of Relative
Employer Info:
Retired Self-Employed
-OR-
Name: ___________________________________________________________________
Address: ___________________________________________________________________
____________________________________________________________________
(City) (State) (Zip)
Phone #: _____________________________
I understand that Arizona City Sanitary District (ACSD) charges a flat fee and I am charged whether the home is occupied or vacant. I understand that ACSD will send the bills to me, as the legal owner or a property manager. I further understand that ACSD does not bill tenants. It is my responsibility to keep ACSD informed of any mailing address changes or legal owner changes.
If my account becomes delinquent and has to be turned over for collections I agree to pay collection fees.
________________________________________/________________
Signature Date
________________________________________/________________
Signature Date
ACSD Form Rev 01/2009 |
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Arizona