Rental Utility Rollover Application

RENTAL UTILITY ROLLOVER APPLICATION

Applicant Information

Today’s Date *

Property Owners Name *

Landlords Name *

Service Address *

Service Address

City

State/Province

Zip/Postal

Country

Mailing Address (if different than above)

City

State/Province

Zip/Postal

Country

Phone *

Email *

Driver’s License Upload

Maximum file size: 516MB

Driver’s License Number *

A S50 Administration Fee is required at the time of each request for rollover and will be added to the first utility bill. *

Call-In Rollover

Automatic Rollover

Applicant Agreement

Please Read Full Applicant Agreement.

The applicant agrees to be responsible for charges for services billed by the City at the address listed during periods when no tenant is responsible for same. lt’s understood that Santa Clara City will transfer responsibility to said applicant upon being notified by a tenant that they are vacating said property. The applicant shall permit the City’s authorized representatives to enter on the customer’s premises at all reasonable times for purposes connected with rendering, billing, or disconnecting utility services. Payment for services is due immediately upon billing and shall become delinquent if not paid by the due date noted on the billing. A penalty of 10% of the unpaid balance will be added to delinquent accounts. The applicant agrees to pay reasonable expenses of collection including attorney’s fees and court costs should it become necessary to use such measure to collect the charges made to the applicant’s account. This application will have the effect of making the applicant responsible for the payment of utility charges incurred at these premises until that responsibility is transferred in one of the following ways: by writing received at the City office two days prior to the requested termination date, or by a tenant completing an application and accepting responsibility for billings. lf I am the owner of the property, I understand that it is my responsibility to notify the City and cancel this Rollover if I sell this property OR if I am a representative for a property management company, I understand that it is my responsibility to notify the City and cancel this Rollover if the management contract is cancelled. Otherwise l/ or the Property Management Company I represent WILL BE RESPONSIBLE FOR ANY ADDITIONAL CHARGES.  The applicant warrants that all the information provided on this statement is true and correct and understands that misleading or false information shall be cause for the City to deny or cancel services and demand immediate payment of any amounts which are due.

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Type Name *

Date Signed *

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