Utility Acct App

Town of Rockford

Utility Customer Account Application

Note: This form must be submitted by the Home/Property Owner on behalf of the tenant for rental properties.

As a Property Owner you are ultimately responsible for all utility bills; the Town of Rockford will not pursue tenants/property managers for any portion, at any time, for any reason for failure to pay the utility charges. It is the Owner’s responsibility to manage their tenants with regard to the utilities and to ensure timely payment. *

I Agree

I Disagree

Service Address *

Tenant Name (if applicable)

********************************* BELOW: FOR OFFICIAL USE ONLY ********************************

E-mail Address *

Service Start Date *

Tenant Phone & E-mail (if applicable)

Garbage Service - Every Tuesday (place at roadside by 5a.m. or night before) *

90 gal cart - $27.15/month (we supply cart)

32 gal cart - $19.50/month (you supply can)

Owner Phone *

Application is for utility services at the address listed below from the Town of Rockford subject to all of the provisions of Town resolutions establishing policies and rates, which are by the reference incorporated into and made a part of this application. *

Applicant Agrees

Applicant Disagrees

Applicant is of legal age: *

Yes

Owner Name *

As the owner of the above named property, I agree to abide by the Town of Rockford municipal ordinances’, State of Washington RCW 35.21 and 35.67, and all other pertinent Town ordinances’ as they now stand or are hereafter amended. The Town may shut off and not restore utilities until all delinquent charges are paid in full and may also employ other legal remedies to collect the unpaid amount. *

Yes

When accepted by the Town, this application becomes a contract committing the Applicant/Customer to pay for the utility services furnished in accordance with the applicable rate schedules, including minimum charges, and for any unpaid service and charges previously rendered to the Applicant/Customer by the Town of Rockford. *

Applicant Agrees

Applicant Disagrees

Mailing Address (if different than Service Address)

*********** Effective Date ************* Service Location ************ Account Number **********

Town of Rockford

20 W Emma Street Rockford, Washington 99030

Rockford Town Hall