CITY
OF
CANAL FULTON
APPLICATION AND AGREEMENT FOR SERVICE
COMMERCIAL
Date you want service
to
begin
Account#
---
Commercial Industrial
Church School
Fire Line
Other
----------
Business
Name:-----------------------------------
Owner Name:
----------------
Service
Address:---------------------------------
Mailing Address
_________________________
_
City:
________________
State:
_____
Zip Code:
___________
_
Phone number
_____________
_
Cell number
_____________
_
Federal
ID#
(for Business):
_____________
S.S.#
_______________
_
D.L.#
____
_
State.
---
Will you own or rent
at
this new location?
Own
Rent
__
_
Name of Landlord (if renting):
______________________________
_
Are
you
currently a City of Canal Fulton customer
7
Yes No
If yes, please give address you are transferring from:
Account#
_________
_
Do
you
want service terminated at the old address?
____
If
yes give date
___________
_
I (we) hereby agree to pay all charges for services at the due dates.
and
to conform.
to
al;
regulations
of
the City of
Canal Fulton pertaining to water and/or sewer service.
Customer Signature:
_____________________
_
Beginning meter reading.
__________
_