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645 Beacon Lite Road, Monument CO 80132 I p: [PHONE REDACTED] I email: [EMAIL REDACTED] Rental Property Water Transfer Request This form is to be used by the homeowner, landlord or property manager to establish service for a separate Town of Monument water account in the tenant’s name. Date of Application Date Service to Begin Service Address Owner / Landlord Information: Name Mailing Address City State Zip Phone Number Email Address Is this property currently being transferred back to the owner or landlord? If yes, please disregard the “New Tenant Information” section of this form. ☐ YES – in between tenants ☐ YES – owner moving into property ☐ NO – new tenant information below Property Manager Information (if applicable): Name Mailing Address City State Zip Phone Number Email Address Previous Tenant Information: Name Forwarding Address City State Zip Phone Number Email Address New Tenant Information Name Mailing Address City State Zip Phone Number Email Address 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 ---PAGE BREAK--- 645 Beacon Lite Road, Monument CO 80132 I p: [PHONE REDACTED] I email: [EMAIL REDACTED] service, until such time as the undersigned gives proper notification to the Water Billing Department that the services are to be discontinued. In the event the undersigned fails to make a particular payment for water service, the Town of Monument shall immediately become entitled to exercise all creditor remedies for collection of amounts owing, which are allowed by law. The undersigned agrees to pay all costs and attorney fees incurred by the Town of Monument in collection of any amount due. • $31.85 minimum base rate for a ¾ inch meter • Water meters are read and billed once per month and due by the 20th of the following month • $12.50 late fee charge for payments not received by the 20th of the month • $25.00 insufficient fund charge • Shutoff notice: $20.00 if shutoff notice is posted/mailed • Shutoff charges: $50.00 for the first offense, $100.00 for the second, $150.00, thereafter • After Hours / Weekend Trip fee for meter service: $40.00 ☐ Paperless Billing ☐ I agree to the terms, conditions, and restrictions of this application and all applicable requirements related to the use of Town of Monument water pursuant to the Town of Monument Municipal Code, Chapter 13 – Public Services. Note: If this is a new purchase and for rent, please attach a copy of the Warranty Deed to confirm ownership. Homeowner Signature Date Tenant Signature Date Below for Internal Use Only Final Meter Read Meter Read By / Date Transfer from Account # Transfer to Account #