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6/26/2015 TOWN OF MONUMENT RENTER WATER CONNECT PLEASE PRINT LEGIBLY DATE OWNER AGENT RENTER SERVICE RENTER CELL MAILING ADDRESS CITY STATE ZIP CODE E-MAIL EMPLOYER OWNER OWNER/AGENT OWNER/AGENT MAILING DATE SERVICE TO PLEASE READ THIS AGREEMENT AND SIGN BELOW: The undersigned hereby requests the Town of Monument to furnish water service to the address designated herein. In exchange for these services, the undersigned agrees to be responsible for all charges for water service provided at the designated address regardless of whether the services are actually used by him, until such time as the undersigned gives proper notification to the Department of Water that the services are to be disconnected. In the event the undersigned fails to make a particular payment for water service, the Town of Monument shall immediately become entitled to exercise any and all creditor’s remedies for collection of amounts owing, which are allowed by law. The undersigned agrees to pay all costs and attorney’s fees incurred by the Town of Monument in collection of any amount due. Water meters are read and billed once per month and due by the 20th of the following month. A $12.50 late fee will be charged for payments not received by the 20th of the month. There is a $25.00 insufficient fund charge. A $20.00 shut off fee is applied to accounts when notice is posted. Water shut off charges are $50.00 for the first offense, $100.00 for the second, and $150.00 thereafter. If a customer requests the Town to check a water meter and it is found to be in good running condition, a $20.00 trip charge will billed to the customer’s account. If a customer requests a water meter to be pulled and checked and it is found to be in good running condition a $50.00 fee will be charged. ATTACH 1ST AND LAST PAGE OF LEASE OWNER/AGENT/RENTER METER READING METER READ BY AND DATE POSTED TO ACCOUNT ACCOUNT NUMBER Town of Monument 645 Beacon Lite Road Monument CO 80132 Margo [PHONE REDACTED] [EMAIL REDACTED]