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2. Owner's Permission to Change Billing Information and/or Responsibility
4. Account #*
5. Service Address*
7. Property Owner Information
9. Property Owner Name(s)*
11. Owner Mailing Address*
13. City*
14. State*
15. Zip Code*
17. Owner Phone Number*
18. Owner's Email Address
20. Property Management Company (if Applicable)
22. Authorization*

    By checking the "I agree" box below, I do hereby authorize the City of Sultan to bill the current tenant(s) occupying property owned/managed by me

    1. I agree
24. Responsibility*

    By checking the "I agree" box below, I fully understand that in accordance with Sultan Municipal Code 13.12.050, I have total responsibility for any, and all utility charges incurred at the above listed property.

    1. I agree
26. Delinquent*

    By checking the "I agree" box below, I further understand that billing of the tenant will be discontinued should the account become delinquent, and any charges incurred in collecting the overdue amounts could become a lien against the property.

    1. I agree
30. Tenant Information
32. Effective Date: *
    Effective Date:

    Must be the 1st day of the month - the city does not pro rate bills.

34. Tenant Name (s)*
36. Tenant Mailing Address*
38. City*
39. State*
40. Zip Code*
42. Phone Number*
43. Email Address
47. 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.
49. Electronic Signature*
50. Date/Time Signed*
    Date/Time Signed

    Date/Time Signed
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field