Tenant Service Agreement Form

You will need information from the Fees & Deposits page to fill out the 'Service Deposit' section of the Tenant Service form.
I/we (if married, both names must be provided)
 
 
(hereinafter, the “TENANT”), desire to be or remain a TENANT of an OWNER (hereinafter, “OWNER”) of the Jefferson Water & Sewer District (hereinafter, the “DISTRICT”) and directly receive the bills for utility service charges for the following service address:
 
 
under this Tenant Service Agreement (hereinafter, “TSA”). The OWNER of the property at such service address is
 
 
and I/we pay rent to the OWNER whose telephone number is:
 
 
For good and valuable consideration, including the right to obtain or continue to receive services from the DISTRICT, the undersigned agree to the as following:
 
1. LIABILITY FOR PAYMENT: TENANT agrees to pay the DISTRICT for utility service charges, and any other applicable DISTRICT fees and/or penalties, for the above service address during their tenancy at such address.
 
2. BILLING: The rates and charges are prepared and billed monthly in accordance with DISTRICT Rules and Regulations. Bills and notices relating to the conduct of the business of the DISTRICT will be mailed to the TENANT at the service address indicated above (or mailing address, if provided below) unless the District is informed of a new mailing address by submission of a new TSA, or unless a DISTRICT change of address form has been completed and returned in a timely manner to the DISTRICT business office. The DISTRICT shall not otherwise be responsible for delivery of any bill or notice
 
3. SERVICE DEPOSIT: In accordance with DISTRICT Rules and Regulations a service deposit is required for a new TENANT account, or for an existing TENANT account where such TENANT has filed for bankruptcy, been disconnected from the DISTRICT system or had delinquent DISTRICT charges certified to the County Auditor for collection since establishing an account. Any customer may apply for relief from such deposit requirement if they qualify for a hardship variance under the DISTRICT Rules and Regulations. The service deposit will be held by the DISTRICT and applied to any outstanding balance due the DISTRICT at the time TENANT account is voluntarily or involuntarily terminated. Where no balance is due, such deposit will be refunded to the TENANT in accordance with DISTRICT Rules and Regulations for refunds.
 
Service Deposit: :: Refer to 'Fees & Deposits' Page
 
4. AUTHORIZATION TO RELEASE INFORMATION: TENANT understands that OWNER may ask for information regarding the status of TENANT’S account with the DISTRICT, and that OWNER may ask to be notified if TENANT account with the DISTRICT becomes delinquent or if the DISTRICT takes any action to notify TENANT of delinquencies or to collect on TENANT delinquent account. TENANT hereby authorizes disclosure by the DISTRICT to OWNER, presenting proper identification, of any and all information about or pertaining to billing, billing delinquency, notices of delinquency, service termination, lawsuits, certification of delinquent charges to the County Auditor to create a lien, and any other actions regarding TENANT’S account or arising out of or in connection with the DISTRICT'S provision of utility services to the service address indicated above and billing for such services.
 
5. RELEASE OF CLAIMS: TENANT, including TENANT’S spouse, family members, employees, agents, officers, directors, successors or assigns, hereby waives TENANT’S right to any and all claims actions, causes of action, liability, damage or claims of damage of every character against the DISTRICT, its employees, agents, board members, legal representatives, attorneys, successors or assigns relating to or arising out of or in connection with the disclosure by the DISTRICT to OWNER of TENANT’S billing information, including billing, billing delinquency, notices of delinquency, service termination, actions at law (lawsuits), certification of delinquent charges to the County Auditor to create a lien, and any other actions regarding TENANT’S account. TENANT further releases and forever discharges the DISTRICT, its employees, agents, board members, legal representatives, attorneys, successors or assigns, from any and all claims, actions, causes of action, liability, damage or claims of damage of every character that TENANT has or may claim to have against the DISTRICT of whatsoever kind and character, whether legal or equitable, which TENANT has or may have now or in the future relating to or arising out of or in connection with any disclosure by the DISTRICT to OWNER of TENANT’S billing information, including DISTRICT billing, billing delinquency, notices of delinquency, service termination, actions at law (lawsuits), certification of delinquent charges to the County Auditor to create a lien, and any other actions regarding TENANT’S account.
 
6. APPROVAL BY OWNER: This TSA is not effective without written authorization from OWNER as indicated on the Owner Service Agreement. Notwithstanding such authorization, the DISTRICT reserves the right to deny a TSA with a TENANT who has been delinquent on a DISTRICT account under another TSA for any Service Address.
 
7. INSPECTION BY DISTRICT: TENANT agrees to be subject to inspection of DISTRICT property in accordance with DISTRICT Rules and Regulations at the Service Address.
 
8. RULES AND REGULATIONS: TENANT further agrees to adhere to all District Rules and Regulations.
 
By signing below, TENANT understands and agrees to all of the foregoing.
 
 
 
 
 
 
 
 
 
 
 
 
  
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Important

 
Your information will be submitted securely to our Customer Service Administration and kept on file. To complete the agreement process, we will require your signature, a copy of a valid driver’s license or state ID along with your deposit. [Deposit amounts will vary depending on the services rendered. Please refer to ‘Fees & Deposit’ Part III located on Page 7 to determine the deposit amount or contact our office for assistance].
 

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