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Request to Bill Tenant

2. This form must be completed by the landlord.

4. Tenant Start Date*
   Tenant Start Date

6. Owner*

8. Service Address*

10. Phone*

11. 2nd Phone

13. Email*

15. Owners Mailing Address*

17. Tenant*

18. 2nd Tenant

20. Phone*

21. 2nd Tenant Phone

23. 2nd Phone

24. 2nd Tenant Alternate Phone

26. Tenant's Mailing Address

    If different from service address

28. Tenant's Email Address

30. I,

    I,

31. Name*

32. , declare under penalty of perjury under the laws of the

    , declare under penalty of perjury under the laws of the

34. State of Washington that all of the information provided on this form is true and correct. I am the owner/agent of the above mentioned property and would like you to bill my tenant for water and sewer services as of the above date. I am submitting this application on behalf of the tenant(s) whose identity I have verified in compliance with the Federal Trade Commission Red Flag Rules.<br><br> I understand that the City will not establish an account for my tenant until the City has received this written request. The termination date for my account will be the closing date indicated above but not prior to the last billing date. A final bill fee of $30.00 will be charged for all final bills. I do hereby acknowledge that as the property owner, I am responsible for water and sewer bills not paid by the tenant, including all fees, delinquent charges, interest and court fees. Further, as the owner of the above mentioned property, I understand the following tenant billing policy and my responsibilities. <br> <ul> <li>Sewer accounts and the sewer and stormwater portion of water/sewer accounts are a lien against the property served and failure to pay same will result in a lien against my property as prescribed by the Revised Code of Washington: RCW 35.21.290 and RCW 35.67.200.</li> <li>If water service is disconnected due to non-payment, service will not be resumed until all delinquent charges together with any administrative fees are paid in full.</li> <li>The owner will receive duplicate copies of delinquent notices whenever the tenant’s account is overdue (RCW35.21.217).</li> <li>A new tenant will require a new “Request to Bill Tenant” form. If a new tenant contacts the city, a form will be sent to the owner, but the new tenant’s account will not be established until the form is received by the City. </li> <li>The owner is responsible to notify the City of Redmond in writing within 14 days of any changes in billing, such as termination of the rental agreement and vacation of the premises (RCW 35.21.217). If a tenant contacts the City to request a final bill, the account will automatically revert to the property owner.</li> </ul> <br> By typing out your name, you have electronically signed this document.

    State of Washington that all of the information provided on this form is true and correct. I am the owner/agent of the above mentioned property and would like you to bill my tenant for water and sewer services as of the above date. I am submitting this application on behalf of the tenant(s) whose identity I have verified in compliance with the Federal Trade Commission Red Flag Rules.
    
    I understand that the City will not establish an account for my tenant until the City has received this written request. The termination date for my account will be the closing date indicated above but not prior to the last billing date. A final bill fee of $30.00 will be charged for all final bills. I do hereby acknowledge that as the property owner, I am responsible for water and sewer bills not paid by the tenant, including all fees, delinquent charges, interest and court fees. Further, as the owner of the above mentioned property, I understand the following tenant billing policy and my responsibilities.
    

    • Sewer accounts and the sewer and stormwater portion of water/sewer accounts are a lien against the property served and failure to pay same will result in a lien against my property as prescribed by the Revised Code of Washington: RCW 35.21.290 and RCW 35.67.200.
    • If water service is disconnected due to non-payment, service will not be resumed until all delinquent charges together with any administrative fees are paid in full.
    • The owner will receive duplicate copies of delinquent notices whenever the tenant’s account is overdue (RCW35.21.217).
    • A new tenant will require a new “Request to Bill Tenant” form. If a new tenant contacts the city, a form will be sent to the owner, but the new tenant’s account will not be established until the form is received by the City.
    • The owner is responsible to notify the City of Redmond in writing within 14 days of any changes in billing, such as termination of the rental agreement and vacation of the premises (RCW 35.21.217). If a tenant contacts the City to request a final bill, the account will automatically revert to the property owner.

    
    By typing out your name, you have electronically signed this document.

36. Signature*

37. Date*
    Date

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field