Commercial Owner/Business Tenant Billing Agreement Commercial Owner/Business Tenant Billing Agreement Effective Date* MM slash DD slash YYYY Service Address* Services Requested Metered Water Fire Service I request the billing for water service and/or fire service as identified above, be mailed to: Business Tenant InformationBusiness Tenant* Bill To Name Mailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code (if different than Service Address)Phone 1Phone 2Email Address Property Owner InformationProperty Owner's Account Number Bill to Acct. No. (if Different) Property Owner* Home PhoneWork PhoneMailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code By State Law, Citrus Heights Water District (CHWD) looks to the land that received the service for payment. For this reason, CHWD requires the Property Owner to keep the account in their name, but as a courtesy, CHWD will bill the Business Tenant. The amount due, if unpaid by the due date, could potentially become a lien on the property and may result in termination of service and additional charges. If the Business Tenant fails to pay any outstanding balance, the Property Owner may be responsible for any past due amount and any additional fees that have been incurred, including late payment penalty, turn-off notice service charge and a Disconnect/Reconnect service charge as set forth in the District's current Water Rates and Miscellaneous Charges and Fees . The District also has the right to place a Certificate of Water Lien on the parcel or pursue other collection opportunities. Property Owners are welcome to call (916) 725-6873 to check the status of their account(s). By completing and signing this agreement, the Property Owner is authorizing CHWD to bill directly the above Business Tenant for metered water service, fire service, or both as selected above. It is the Property Owner's understanding that all facilities that are on the building side of the District's control valve are owned and maintained by the Property Owner who assumes any attendant liability for said facilities. If you have questions regarding billing please contact us at (916) 725- 6873. I have read and consent to the terms of this agreement. Property Owner's Signature Date MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged. SIGN UP FOR ONLINE BILL PAY TODAY! GO PAPERLESS NOW
