City of Temple Terrace Customer Service

CITY OF TEMPLE TERRACE UTILITY SERVICE CONTRACT

2. Accepted By
   Accepted By
4. Accepted Date
   Accepted Date
6. Customer-location Id
8. Services
   __Garbage __ Water __Irrigation __Sewer
10. Requested Service Start Date*
    Requested Service Start Date
12. Customer Last Name *
14. Customer First Name *
16. Service Address *
18. Zip *
20. Customer Phone Number *
22. Customer Email Address *
24. Receive Utility Bill VIA E-mail
26. Mailing Address *
28. Owner/non-owner *

    1. Owner$100.00

    1. Tenant $200.00
30. Property Owner's Name
32. Property Owner's Address
34. Property Owner's Phone Number
36. Signature *
38. Please attach lease or closing disclosure *
40. Government Issued ID.*
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field