City of Temple Terrace Customer Service

CITY OF TEMPLE TERRACE UTILITY SERVICE CONTRACT

2. Accepted By
   __________________

   __________________

4. Accepted Date
   ___________________

   ___________________

6. Customer-location Id
   __________________

   __________________

8. Services
   __Garbage __ Water __Irrigation __Sewer

   __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