CITY OF BREMERTON
Public Works and Utilities - Billing
345 6th Street, Suite 100
Bremerton, WA 98337-1891
Office (360) 473-5316 | Fax (360) 473-2330
Email: billing@ci.bremerton.wa.us
Account No.
* * * PLEASE COMPLETE, SIGN & RETURN * * *
Service Address Move In / Out Date
TENANT CHANGE FORM
I,
, as owner of the above listed property, I am informing you that:
My tenant moved in.
My tenant moved out (bill to Owner or Property Manager)
I've added a Property Manager
I've removed a Property Manager
As a courtesy to the owner, only the owner may request to have the billing sent to the tenant. If the tenant vacates leaving outstanding
charges, the City will not go to collections to get payment from the tenant. The unpaid charges stay with the property and therefore
become the responsibility of the owner.
There will be a $5 fee to add a tenant.
Owner Signature
Section A: TENANT INFORMATION FOR BILLING
Date
Section B: AGENT/PROPERTY MANAGEMENT/POA
Name:
Last First MI
Section C: OWNER INFORMATION FOR OWNER ACCOUNT
Name:
Last First MI
Rev 01/07/20
NOTE:
Cell:Ph:
Cell:Ph:
Number/Street/Apt. No. City State Zip
Mailing Address:
Number/Street/Apt. No. City State Zip
Mailing Address:
Mailing Address:
Service Address/PO Box City State Zip
Email:
Name:
Last First MI
Last First MI
Co-Name:
Cell
Home
Phone:
Cell
Home
Phone:
(Print Name)
Both*
*
Select "Both" to receive a paper and electronic bill
E-Bill Only
Email:
Email:
Agent Name:
Please choose one of the following Off Cycle Billing options for your tenant move in/out:
Request the City of Bremerton to read the meter for a fee of $23
Meter read declined. Send next bill to Owner/Property Management. Will handle move in/out. No fee.
