City of Meridian - Utility Billing Renter's Addendum

Fields marked with * are required.

I do hereby declare that I am tenant and therefore a resident at the following address and will be responsible for payment of the City of Meridian Utility Bill.
 
Address Tenant Occupying - Street *
 
 
Address Tenant Occupying - City *
 
 
Address Tenant Occupying - State *
 
 
Address Tenant Occupying - Zip Code *
 
 
Tenant Name: *
 
 
Tenant Phone # *
    
 
Tenant Email Address
 

Do you want the bills to go to a different address other than the service address?

Have you previously lived at a Meridian City address?

 

   I acknowledge that, during my tenancy, I will receive a monthly statement from the City of Meridian with a balance due each month. I agree that I will submit payment for that balance on time each month. If payment is not received each month I acknowledge that my landlord will receive a copy of the delinquent notice sent to my residence. *

 

   By electronically signing this form I permit the City of Meridian to release any information requested about this account to my landlord. The information released may be, but is not limited to; the account balance, payment history, or delinquency status. *

 

   I acknowledge that there will be a one-time Renters Fee of $20 assessed to my first bill. *

 
Driver's License or Other Govt. Issued ID# *
 
 
Issuing Agency *  (Idaho DL, Military ID, Etc)
 
 

TERMS OF ACCEPTANCE and SIGNATURE
I, the Tenant for this Renter's Addendum, 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.
 
 
 
 

Please review the above document prior to submission. You are electronically signing this document stating that the information provided is true and correct. In some instances we have seen auto fill alter the valid requested information. Forms with invalid information can not be used.