This is the service contract for a TENANT. Please complete and bring with you to the
office of Utility Billing, 100 S. Market Street, Troy, Ohio (first floor). Having this
form completed will expedite the sign-up process. All adults sharing the living space
must appear at the office, bringing a Driver’s License for identification purposes. All
adults sharing the living space will be listed on the contract. If you are a married
couple with no other adults sharing your living space, only one of you must appear at
the office with your Driver’s License for identification purposes.
Account No.____________________________________ Date ________________________________
Social Security No. _____________________________ Driver Lic No. ________________________
Home Phone ________________________________Work Phone ______________________________
Employer ___________________________________E-Mail__________________________________
I hereby apply for water / sewer / recycling at ______________________________________________
And I agree to conform to all rules and regulations that are now in force or may be hereinafter enacted
concerning the use and payment for the utilities furnished by the City of Troy, Ohio. .
APPLICANT (printed) ______________________________________________________________
APPLICANT (signature) ______________________________________________________________
Property owner/guarantor ____________________________________________________________
City Rep. signature _____________________________________________________________
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