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2. Effective Date of Agreement*
   Effective Date of Agreement

   The District will not prorate between billing periods

4. Service Address*
6. I request the billing for water service as identified above, be mailed to:
8. Tenant / Management Information
10. Tenant / Management Name*
12. Mailing Address*
14. City*
15. State*
16. Zip Code*
18. Phone Number*
19. Secondary Phone
21. Owner Information
23. Property Owner Name*
24. Mailing Address*
26. City*
27. State*
28. Zip Code*
30. Phone Number*
31. Secondary Phone
33. Email Address*
35. Acknowledgement

    I acknowledge that as the property owner, I am responsible for payment of all charges incurred and that service to my property may be disconnected, or a lien may be placed if charges are not paid.

    By State Law (Government Cody section 54347, Water Code section 22079), Carmichael Water District has the right to seek payment from the legal property owner for unpaid water service account balances. Unpaid balances on water accounts may be applied to the real property and could result in a lien being placed against the property title.

    For this reason, the District requires the Owner to keep the account in their name, but as a courtesy, the District will bill their Tenant/Management. The District charges a non-refundable application fee for the submission of this agreement in the amount set forth in the District's Fiscal Year Fee Schedule. The District will not prorate any bills/charges when a Tenant/Management changes.

    Property owners are responsible to notify the District of any changes to this agreement. I (owner) acknowledge that the District does not come between any Tenant/Management owner issues that may arise by signing this agreement. If the District determines that the payment history of the Tenant/Management is unacceptable, the District may terminate this agreement at any time without notice.

    I have read and consent to the terms of this agreement.

37. Property Owner Name*
39. Confirm and Authorize*

    1. By selecting this box, I confirm that all information provided is true and accurate and I authorize this request.
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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field