Fillable 21014 UtilityServiceForm 20181016

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21014 UtilityServiceForm 20181016

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Country of origin: US
File type: PDF

U.S.A. forms for City of Hood River

BROWSE CITY OF HOOD RIVER (OR) FORMS

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CITY OF HOOD RIVER
UTILITY ACCOUNT SERVICE FORM
$10 processing fee is applied to new and terminating accounts (applied to first & last bill)
Date called:
Effective Date:
Account Number (Office use only):
Account Type (Office use only): Residential: Commercial: Low Med. High
Move In: Move Out: Owner: Renter:
Occupant(s) Name(s)
As it will appear on account:
Name #1:
Name #2:
Name #3:
Name #4:
Service Address
Mailing Address
Address:
Address:
City:
Phone:
State: Zip:
Email:
If you are the renter you must submit the Owner(s) information below.
Owner(s) signature is REQUIRED for service to be setup.
Owner(s) Name
Owner(s) Address
Name #1:
Address:
Name #2:
Name #3:
City:
Phone:
State: Zip:
Email:
I UNDERSTAND THAT IF I DO NOT PAY MY UTILITY BILL IN A TIMELY MANNER, THE OWNER OF THE
PROPERTY WILL BE NOTIFIED. I ALSO UNDERSTAND THAT SERVICES MAY BE TERMINATED UNTIL
PAYMENT IS RECEIVED. AS CONSIDERATION FOR UTILITY SERVICES PROVIDED BY THE CITY OF HOOD
RIVER, I AGREE TO COMPLY WITH ALL APPLICABLE ORDINANCES, RESOLUTIONS, AND POLICIES OF
THE CITY OF HOOD RIVER
Occupant Signatures(s)
x
Owner Signatures(s)
x
V20181016
CityofHoodRiver
WaterDepartment
Thisformmustbecompletedandreturnedbeforeanewutilityaccountcanbesetup.
Formsmaybereturnedvia:
Inperson/mail: 2112
nd
St.,HoodRiverOR97031
Email: utilities@cityofhoodriver.com
Fax: (541)387‐5289

Questions/concerns?
HoodRiverUtilityBillingDepartment
(541)387‐5216
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21014 UtilityServiceForm 20181016

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Completed 2 November 2019

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