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TOWN OF MINDEN Agreement and Request for WATER and TRASH SERVICE The undersigned property owner(s) within the Town of Minden do hereby request to be furnished water and trash service from the Town of Minden, upon the terms and conditions, or under the rules and regulations, as may from time to time be adopted, changed or modified. The undersigned agrees to pay any and all connection charges and rates for the water and trash service as established. The undersigned further agrees to pay reasonable attorney fees and court costs incurred by the Town of Minden in enforcing any of the rules and regulations of the Town or in collecting any sums owed to the Town. DATE SERVICE NAME (Please Print): Last First RENTER: Last First MANAGEMENT COMPANY: Street Address: Mailing Address: SIGNATURE Please return to: Town of Minden 1604 Esmeralda Ave. Suite 101 Minden, NV 89423 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] TOWN OF MINDEN NEW SERVICE REQUEST & AGREEMENT FORM REV. FEB 1, 2010 ACT#: Residential:____ Commercial:____ UPDATE: Computer:____ Card File:____ New Connection: Trash Container Date Ordered: / / Meter Needed:_____ Installation Fee Work Order TO BE FILLED OUT BY MINDEN OFFICE PERSONNEL ONLY: