Owner/Management Billing Agreement Owner/Management Billing Agreement Effective Date* MM slash DD slash YYYY Service Address*I request the billing for water service as identified above, be mailed to: Management InformationManagement Name*Contact Name*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code (if different than Service Address)Phone 1*Phone 2Management Company's Email Address Owner InformationProperty Owner*Property Owner's Account Number*Home Phone*Work PhoneMailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Property Owner's Email Address By State Law, Citrus Heights Water District (CHWD) looks to the land that received the service for payment. For this reason, CHWD requires the Owner to keep the account in their name, but as a courtesy, CHWD will bill their Management Company. The amount due, if unpaid by the due date, could potentially become a lien on the property. Per Policy 7170.01: Past due bills not paid by authorized representative will be transferred back to the property owner after 3 months past due. If the Management Company fails to pay any outstanding balance, the Owner will be responsible for any past due amount and any additional fees that have been incurred, including late-payment, 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 Lien on the parcel or pursue other collection opportunities. Owners are welcome to call (916) 725-6873 to check the status of their account(s). I have read and consent to the terms of this agreement. Property Owner's Signature*Date MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged. Δ SIGN UP FOR ONLINE BILL PAY TODAY! GO PAPERLESS NOW
