MATERSEWERICARBACE SERVICE APPLICATION. AGREEMENT, & ADJUSTMENTS City of Covington, Virginia Central Accounting Office PO. Box 900 Covington, VA 24426 (540). 965-6314 MAILING ADDRESS DATE ACCOUNT NUMBER SPOUSE NAME OWNERS ADDRESS NAMEE ADDRESS SOCIALS SECUNITY NUMUDE BY HOMET TELEPHONE NUMBER EMPLOVERSRANE AUSINESS PHONEN NUMBER NIMBER TURN ONDI CUTOFF CHANGE MAILING ADDRESS D CHANGE OF ADDRESS D NEW ACCOUNT OWNER D CHANGE OF NAME & CODE NO. D NEWS ACCOUNT RENTER D DISCONTINUE SERVICE D CURRENTARREARS SEWER DEPOSIT SEWER DETALL AMOUNTOF ORISINAL CHARGE CORRECT AMOUNT TOBEPAD INCREASE CHARGE DEBIT AMOUNT: DECREASE CHARGE CREDIT MMOUNT OTHER TOTAL WATER GARBAGE WATER GARBAGE IN CONSIDERATION OF SERVICES PROVIDED, BY THES CITY OF COVINGTON, THE APPLICANT AGREES TO PAY THE FOLLOWING CHARGES FOR THE TOTAL AMDUNT WATER SEWER GARBAGE PER BILLING PERIOD THE CURRENT RATE. WILL SE: APPLICANT FURTHER AGREES. TO PAYI FOR ALL ABOVE SERVICES FURNISHED SAID PREMISES AT ANY NEW RATE: HEREAFTER ESTABLISHED IN ACCORDANCE WITH THE CITY ORDINANCES GOVERNING WATER, SEWER AND. GARBAGE APPLICANT: AGREES TO: NOTIFYTHE CITY WHEN MOVING FROM ONE ADDRESS: TO ANOTHER: IN THE. CITY ANDTO PAYANY APPLICANT RECOGNIZES THE CITY'S RIGHT TO DISCONTINUE AT ANY TIME THE FURNISHING OF WATER, SEWER. AND: GARBAGE SERVICES IF BILLS ARE NOT PAID ATTHE PROPER TIME OR FOR VIOLATION! OF ANY RULE GOVERNING WATER, CHARGES. APPLICANT AGREES TO PAY A DEPOSIT: IN ACCORDANCE WITH THES CITY ORDINANCES, CHANGE OF ADDRESS CHARGE ESTABLISHED BY THE CITY COUNCIL APPLICANT WWILL NOTIFY THE CITY WHEN SERVICE IS TO BE DISCONTINUED. SEWER OR GARBAGE. EXPLANATION By APPLICANTS: SIGNATURE DATE: APPROVED! BY AGCOUNTING SUPERVISOR: