2. 

3. 
   

   REQUEST TO CHANGE STORMWATER BILLING FROM OWNER OF PROPERTY TO RENTING TENANT ACCOUNT

4. 
   

   City of Tarpon Springs
   Utility Billing Division
   PO Box 5004
   Tarpon Springs, FL 34688-5004
   Phone: (727) 942-5609
   Email: ubcts@ctsfl.us

8. This is to authorize the City of Tarpon Springs to bill the monthly stormwater fee to the existing account located at

10. Address*
12. City*
13. State*
14. Zip Code*

16. and with the account number

17. Account #*

19. The billing to the tenant will be effective as of the last billing date that the owner received stormwater charges. Any prior balance under the owner's account must be paid in full.

21. Tenant Name*
22. Owner Name*
24. Tenant Signature*
25. Owner Signature*
27. Date Signed*
28. Date Signed*
30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field