Fillable REAL ESTATE/ MANAGEMENT SERVICE APPLICATION (City of Pooler)

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REAL ESTATE/ MANAGEMENT SERVICE APPLICATION (City of Pooler)

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REAL ESTATE/ MANAGEMENT
SERVICE APPLICATION
City of Pooler
Utility Billing Department
100 US HWY 80 SW
Pooler, GA 31322
Ph (912) 748-4800
Fax (912)748-6777
utilitybilling@pooler-ga.gov
Email address __________________________________________________
seeking to participate in the program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in
OFFICE USE ONLY
Applicant/Owner Information
ACCT_________________________________________________________________
________________________________________________________________________________________________________________________
"The following information is required by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants
Today's Date _________/__________/___________
Date to Start Service _________/__________/___________
Service Address_____________________________________________________________________________________________________________
Contact Name and Position in Company__________________________________________________________________________________________
Buisness/Owners Name _____________________________________________________________________________________________________________
DATE ENTERED _________/__________/___________
BY:_________________________________________________________________
Mailing Address ___________________________________________________________________________________________________________
Phone # ( ) -
Tax ID # or SSN of Owner ________________________________________
Phone # ( ) -
Fax # ( ) -
"This is an Equal Opportunity Program. Discrimination is prohibited by Federal Law.
Complaints of discrimination may be filed with the Secretary of Agriculture. Washington DC 20250"
evaluation of 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 observance or surname.
□ White, not of Hispanic origin □ Hispanic □ Black, not of Hispanic origin
□ Asian or Pacific Islander □ American Indian or Alaskan native
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REAL ESTATE MANAGEMENT SERVICE APPLICATION (City of Pooler)

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Completed 4 August 2020

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