City of Meridian - Utility Billing Directive Form

Fields marked with * are required.

Today's Date
 
 
Account #
 
Address Tenant Occupying - Street *
 
 
Address Tenant Occupying - City *
 
 
Address Tenant Occupying - State *
 
 
Address Tenant Occupying - Zip Code *
 
 
Move In Date *
 
 

The Property Owner/Manager of the above described property and account, does hereby instruct the Meridian Utility Billing Services (MUBS) to prepare the monthly billing statement for the necessary services to the above referenced address in the following tenant name(s) and relinquish my/our authority to terminate services to property while occupied by the tenant.

 
 
Tenant Name(s) * - (List all tenants on lease!)
 
 
Tenant Phone # *
    
 

   I do hereby acknowledge that I will remain responsible for unpaid account balances for water, sewer, and garbage, as provided by Meridian City Code. If my tenant moves out and leaves a balance of any size I understand that as the property owner I will be responsible for payment of said debt. *

 

   I will ensure that all balances prior to this tenant’s move-in are paid and understand that any unpaid balances can/will result in service disconnection to the above-stated address. I also understand that tenants will be directed to contact their landlord or Property Owner/Management Company should the utilities be terminated due to non-payment of services prior to their move-in date. *

 

   I understand that this utility billing account will remain in the “Property Owner” name and sent to the person named herein at my request. I will notify the City of Meridian Utility Billing Department of vacancy for a final read. *

 

   I acknowledge that I will not receive monthly statements for this account. If the account becomes delinquent I will be sent a copy of each delinquency notice that is sent to the tenant. I further agree that any and all amounts due for water, sewer and garbage shall constitute a lien on the real property which will secure the amounts due. Termination of service to the property will not release any lien for amounts due. *

 

   I permit the City of Meridian to release any information requested about this account to the aforementioned tenant during their tenancy. The information released may be, but is not limited to; the account balance, payment history, or delinquency status. *

 

I do hereby certify that I am the owner or the duly authorized agent to make this request for the owner of the subject property receiving the service. By signing below, I further acknowledge that I have read, understand, and agree to the Terms and Conditions set forth above.

 

Please check either Owner or Property Manager - a selection of one or the other is required *

 

 

TERMS OF ACCEPTANCE and SIGNATURE I, the Owner/Property Manager for this Billing Directive, warrant the truthfulness of the information provided in this application.

 
Electronic Signature * (Please type your First and Last Name)
 
 
Acceptance Checkbox  *
  I understand that by signing this document I acknowledge and agree to the above Terms of Acceptance.