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TODAY’S DATE: ______________________________ REQUESTED SERVICE DATE: _______________________________CONNECT: __________________________________FINAL: ______________________________________________RENT [ ]OWN [ ]PROPERTY MANAGEMENT [ ]DOES THE HOME HAVE A POOL OR SPRINKLER SYSTEM?YES [ ]NO [ ]APPLICANT NAME:_________________________________________________________________FIRSTLASTCO-APPLICANT NAME:_________________________________________________________________FIRSTLASTSERVICE ADDRESS: ________________________________________ZIP CODE: ______________________________BILLING ADDRESS: ________________________________________ZIP CODE: ______________________________APPLICANT ID/DL #______________________________________________________________________________CO- APPLICANT ID/DL #______________________________________________________________________________CELL PHONE #: __________________________________ ALT PHONE #: ______________________________________EMAIL ADDRESS: ____________________________________________________________________________________OFFICE USE ONLY:DEPOSITCONNECTION FEETRANSFERAMOUNT: $ _____________________AMOUNT: $ ______________________AMOUNT: $ ______________________ACCOUNT # ______________________________________CHECK/MONEY ORDER #: ________________________METER SERIAL #: __________________________________METER READING: ______________________________EFFECTIVE DATE: __________________________________BILL DAYS: ____________________________________COMMENTS: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________APPROVAL ________________________________(PLEASE PROVIDE A COPY OF YOUR ID WHEN REQUESTING TERMINATION OF SERVICE) ................
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