Fillable CITY OF THORNTON BUDGET BILLING APPLICATION (City of Thornton)

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CITY OF THORNTON BUDGET BILLING APPLICATION (City of Thornton)

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4/5/2004
CITY OF THORNTON
BUDGET BILLING APPLICATION
Please complete this form, print it, and bring to the Utility Billing Office along with proof of
ownership for the premise.
OWNER’S NAME :
DATE:
OCCUPANT’S NAME: DATE:
SERVICE
ADDRESS:
TELEPHONE Owner Owner
NUMBER: (daytime) (home)
Occupant Occupant
(daytime) (home)
BUDGET BILLING
ACCOUNT NUMBER:
I have read the attached guidelines for the budget billing program, and agree to the
conditions contained within. Regardless of occupancy, the owner of the premise shall
remain responsible for all water service charges attributed to the premises. (Thornton
Municipal Code Section 74-122)
Owner’s Signature Tenant’s Signature
DO NOT WRITE BELOW THIS LINE
Proof of ownership checked:
Budget billing units:
Settlement months:
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CITY OF THORNTON BUDGET BILLING APPLICATION (City of Thornton)

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Completed 16 July 2020

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