SERVICE APPLICATION AND AGREEMENTService Application and Agreement • July 31st, 2019
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
WIMBERLEY WATER SUPPLY CORPORATIONService Application and Agreement • July 20th, 2022
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
Wylie Northeast SUDService Application and Agreement • October 6th, 2016
Green Valley Special Utility District Check List for New Owners or RentersService Application and Agreement • November 30th, 2020
o to include all person(s) that need/require access to the GVSUD Water/Sewer account. (If you are not on the application you will not be on the account and GVSUD will not be able to speak with you regarding any questions/concerns you may have.)
Wylie Northeast SUDService Application and Agreement • October 18th, 2019
WATER SUPPLY CORPORATION SERVICE APPLICATION AND AGREEMENTService Application and Agreement • October 4th, 2022
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • May 23rd, 2019
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
KINGSLAND WATER SUPPLY CORPORATIONService Application and Agreement • May 20th, 2022
WATER SERVICE APPLICATION AND AGREEMENTService Application and Agreement • August 5th, 2021
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • March 24th, 2022
THE COVES WATER SUPPLY CORPORATIONService Application and Agreement • August 12th, 2022
All personal information in the customer’s account (address, phone number, driver’s license, usage, billing and payment records) is automatically kept confidential unless requested by the customer to opt out. HB 872, Section 812.052 of the utilities code effective June 18, 2021
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • July 9th, 2019
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race national origin of individual applicants on the basis of visual observation or surname.
KENTUCKYTOWN WATER SUPPLY CORPORATION SERVICE APPLICATION AND AGREEMENTService Application and Agreement • September 20th, 2021
AGREEMENT made this day of , 20 , between Kentuckytown Water Supply Corporation, a corporation organized under the laws of the State of Texas (hereinafter called the Corporation) and , (hereinafter called the Applicant and or Member), Witnesseth :
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • July 30th, 2020
The District shall sell and deliver water and/or wastewater service to the Applicant and the Applicant shall purchase, receive, and/or reserve service from the District in accordance with the Service Policies of the District, as amended from time to time by the Board of Directors of the District. Upon compliance with said Policies, including payment of a deposit, the Applicant shall become eligible to receive service.
ContractService Application and Agreement • April 5th, 2021
Account #: Membership: Service Application: Proof of Ownership: Bell CAD Prop ID: Easement: Meter Serial #:Service Application and Agreement • May 20th, 2021
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • November 22nd, 2022
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
Account #: Membership: Service Application: Proof of Ownership: Bell CAD Prop ID: Easement: Meter Serial #:Service Application and Agreement • January 26th, 2022
Riverside Special Utility DistrictService Application and Agreement • September 1st, 2021
WATER SUPPLY CORPORATION SERVICE APPLICATION AND AGREEMENT CORPORATION USE ONLYService Application and Agreement • June 19th, 2019
ALTOGA WATER SUPPLY CORPORATION SERVICE APPLICATION AND AGREEMENTService Application and Agreement • June 13th, 2007
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way.
GEORGETOWN COUNTY WATER AND SEWER DISTRICTService Application and Agreement • July 16th, 2009
This application and agreement form must be completed and signed only by the person(s) requesting service. For new service, the District may request a map or plat showing the applicant’s preferred meter location on the premises.
WATER SERVICE APPLICATION AND AGREEMENTService Application and Agreement • July 23rd, 2015
an existing water service. In addition, provide payment for any outstanding combined utility charges (for an existing account). Please Note: Billing for combined utilities will begin on the date the meter is installed.
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • April 26th, 2017
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
WEST GREGG SPECIAL UTILITY DISTRICT SERVICE APPLICATION AND AGREEMENTService Application and Agreement • April 28th, 2011
The District shall sell and deliver water and/or wastewater service to the Applicant and the Applicant shall purchase, receive, and/or reserve service from the district in accordance with the Service Policies of the District, as amended from time to time by the Board of Directors of the District. Upon compliance with said Policies, including payment of a deposit, the Applicant shall become eligible to receive service.
Service Application and AgreementService Application and Agreement • May 26th, 2015
AGREEMENT made, between applicant/customer and Parker County Special Utility District, a political subdivision created under the laws of the State of Texas (hereinafter called the District) and (hereinafter called the Applicant and/or Customer).
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • December 27th, 2020
Walston Springs Water Supply Corporation, a corporation organized under the laws of the State of Texas (hereinafter called the
SERVICE APPLICATION AND AGREEMENT – TCEQ Reg. 290.46(i)Service Application and Agreement • August 30th, 2017
This AGREEMENT is made this the day of , 20 , between Winkler Water Supply Corporation, a corporation organized under the laws of the state of Texas (hereinafter called the Corporation) and
Service Application and AgreementService Application and Agreement • September 26th, 2019
AGREEMENT made, between applicant/customer and Parker County Special Utility District, a political subdivision created under the laws of the State of Texas (hereinafter called the District) and (hereinafter called the Applicant and/or Customer).
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • September 13th, 2022
between Gonzales County Water Supply Corporation, a corporation organized under the laws of the State of Texas (hereinafter called the Corporation) and ___________________________________ (hereinafter called the Applicant and/or Member),
THE COVES WATER SUPPLY CORPORATIONService Application and Agreement • June 20th, 2018
Previous Member: Lot #’s: Legal Description: Phase #: Date Water to Begin: Service Address: Member’s Name: Member’s Address: City: Zip:
WATER SERVICE APPLICATION AND AGREEMENT - TENANTService Application and Agreement • March 4th, 2022
It is further agreed that in the event any charges, fees or rents for such service are not paid by the undersigned within 15 days of billing, the undersigned waives the right of confidentiality in the matter of such unpaid amounts and authorizes the city to inform the owner of the property, or the owner's agent, of the amount of the unpaid balance.
SERVICE APPLICATION AND AGREEMENTService Application and Agreement • November 16th, 2020
NOTE: FORM MUST BE COMPLETED BY APPLICANT ONLY. A MAP OF SERVICE LOCATION REQUEST MUST BE ATTACHED IF NEW SERVICE IS REQUESTED.
ContractService Application and Agreement • May 24th, 2017 • New York
TELECHECK SERVICE APPLICATION and AGREEMENT VISA/MC MID# Location of Area Group# Parent ID# TCK BT# TCK Loc # DataEntry Only SIC Code Description Assoc. Code Assoc. Name (1) MERCHANTS INVOICING (BILL-TO) INFORMATION Legal Company Name Your DBA Name (if applicable) Store # Address Suite # City State Zip Code First/Last Contact Name Contact Title Business Phone # Contact Email Address Business Fax # Special Instructions (2) MERCHANT LOCATION INFORMATION ADDRESS SAME AS INVOICING (BILL-TO) Legal Company Name Your DBA Name (if applicable) STORE # Address (No P.O. Box) Suite # City State Zip Code Contact Name Contact Title Contact Email Address Phone # Fax # Website (required for Online) WWW (3) BUSINESS AND OWNERSHIP INFORMATION Business/Product lines for last 2 years Annual Revenues Name (as it appears on your income tax return) State/Federal TAX ID (as it appears on your income tax return) State Incorp. Started (MM/YYYY) # of Employees Dun & BradStreet ID Yes No Is a publicly tr
SERVICE APPLICATION AND AGREEMENT (CONT’D)Service Application and Agreement • May 20th, 2008
Upon the undersigned Applicant, singly or collectively, complying with all terms and conditions of service, the Wylie Northeast Special Utility District will furnished water service to Applicant at the above-reference property and Applicant shall purchase and receive water service from the district in accordance with the district’s Rate Order and other applicable service policies, if any. Applicant further agrees to pay all applicable fees and charges for such water service in accordance with district’s Rate Order, as amended from time to time.
