LANDLORD AGREEMENT

PROPERTY OWNER / LANDLORD INFORMATION

Service Address (Include City, State, Zip) (required)

Landlord First and Last Name (required)

Landlord Phone (required)

Landlord Email (required)

Landlord Mailing Address (Include City, State, Zip) (required)

NEW TENANT INFORMATION

Tenant First and Last Name (required)

Tenant Phone (required)

Tenant Email (required)

Tenant Mailing Address (Include City, State, Zip) (required)

Date Tenant is moving in (required)

**** IN AGREEMENT TO THE TERMS, PLEASE READ AND TYPE NAME AND DATE BELOW

BY SUBMITTING THIS FORM, I HEREBY AUTHORIZE THAT THE ELECTRIC UTILITY BILL BE CHARGED TO ANOTHER PARTY AND THAT THEY WILL BE REQUIRED TO TURN IN A SERVICE APPLICATION AND PAY THE DEPOSIT OF $250.00. HOWEVER, I ACKNOWLEDGE THAT I AM ULTIMATELY RESPONSIBLE FOR THE PAYMENT OF THIS ELECTRIC SERVICE ACCOUNT. SHOULD THE TENANT DEFAULT ON PAYMENT, I WILL BE RESPONSIBLE FOR ANY PAST DUE CHARGES. I ALSO AGREE TO SUBMIT A "HOMEOWNER'S ACCOUNT APPLICATION" (SEE LINK BELOW) WITH THIS LANDLORD AGREEMENT AND PROVIDE MY S.S. #, DRIVER LICENSE AND/OR TAX I.D./EIN # FOR BUSINESSES.

Property Owner / Landlord Type Full Name (required)

Date (required)

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