Owner/Tenant Agreement Owner/Tenant Billing Agreement Date of Application* MM slash DD slash YYYY Effective Date* MM slash DD slash YYYY Service Address*I request the billing for water service as identified above, be mailed to: Tenant InformationTenant 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 2Tenant's Email Address* Owner InformationProperty Owner Name*Property Owner's Account NumberHome PhoneWork 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 tenants. As a result, CHWD requires a deposit, in the amount of $223.00, on all locations that are tenant occupied and are billed to the tenant as directed on the Owner/Tenant Agreement. It is the responsibility of the Owner to pay the deposit. The deposit will be retained for the duration of this agreement and any subsequent Owner/Tenant Agreements until the bill is changed back into the Owner’s name. At that time, the Owner must make a written request for the refund of the Deposit balance. Any outstanding balance on the account must be paid in full prior to the refund. Interest will be credited to the deposit account on a quarterly basis. If the Tenant fails to pay any outstanding balance, the Owner may be responsible for any past due amount and any additional fees that have been incurred, including late-payment penalties, 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. Past due bills not paid by the tenant(s) will be transferred back o the property owner after 3 months past due per Policy 7170.01. I have read and consent to the terms of this agreement, including payment of the required deposit to complete this process. 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
