Tenant Application and Deposit for Water and Sewer Service

All fields are required.

Name of Tenant

Service / Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tenant Phone

(###)

###

####

Tenant Email

Property Owner

Property Rental Start Date

YYYY

Length of Lease

Digital Signature

I agree to pay a $100 rental deposit fee to Broad Creek Public Service District to be held interest free by the District and intended to guarantee payment of bills for water and sewer service at the above mentioned “Service / Billing Address”. I understand that if at any time service is disconnected due to tenant damages to system or for nonpayment of fees, a $140 reconnect fee must be paid to reconnect to the District system. I further agree to provide the District with a forwarding address at the end of the lease term for purposes of final billing. I understand that the due date of all bills is not later than fifteen (15) days from the billing date. An account is considered delinquent if not paid within thirty (30) days from the billing date. All delinquent accounts will be charged a late fee of 1.5% of past due balance. Failure to pay off the delinquent balance will result in service being discontinued.

Date

YYYY

Tenant Application and Deposit for Water and Sewer Service

Information

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