Fillable TENANT WATER/SEWER BILLING AUTHORIZATION FROM PROPERTY OWNER FORM (City of Winchester)

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TENANT WATER/SEWER BILLING AUTHORIZATION FROM PROPERTY OWNER FORM (City of Winchester)

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BROWSE CITY OF WINCHESTER (VA) FORMS

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“To provide a safe, vibrant, sustainable community while striving to constantly improve
the quality of life for our citizens and economic partners.”
Rouss City Hall Telephone: (540) 667-1815
15 North Cameron Street FAX: (540) 662-5803
Winchester, VA 22601 Website: www.winchesterva.gov
TENANT WATER/SEWER BILLING AUTHORIZATION
FROM PROPERTY OWNER FORM (Please Print)
ACCOUNT NUMBER:
DATE:
ADDRESS OF PROPERTY:
DELIVER WATER/SEWER BILLS TO
(TENANT’S NAME):
TENANT TELEPHONE NUMBER:
PROPERTY OWNER NAME:
PROPERTY OWNER TELEPHONE:
PROPERTY OWNER ADDRESS:
EFFECTIVE DATE:
The undersigned owner of this property requests that the designated bills be delivered to the
tenant listed above. The owner understands that this does not relieve him/her of
responsibility for any amount that the tenant fails to pay according to below excerpt from
The Winchester City Code, Chapter 29, Section 29-16 Billing Terms. This form must be filled
in completely on the right hand side (except for the account number) by owner or property
manager.
WINCHESTER CITY CODE, CHAPTER 29-UTILITIES, SECTION 29-16. BILLING TERMS
The owner of the property shall be responsible to the City of Winchester for the payment of
water and sewer bills. On written request of the owner of the property, the tenant may be
billed in the owner’s name for water and sewer service, but this request shall not relieve the
owner from responsibility.
PROPERTY OWNER SIGNATURE_______________________ DATE_________
PLEASE RETURN IMMEDIATELY TO: CITY OF WINCHESTER
PUBLIC SERVICES DEPARTMENT
ATTN: Customer Service TBA
P.O. Box 75
Winchester, VA 22604
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TENANT WATERSEWER BILLING AUTHORIZATION FROM PROPERTY OWNER FORM (City of Winchester)

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Completed 22 March 2021

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