All fields with an asterisk * are required. You must have JavaScript enabled to use this form. Service Address Troutdale, OR 97060 Account Number Effective Date Reason for form: - Select -MOVE INOTHER Explantion: Are you the? - Select -BuyingRentingOther This property will be... - Select -Personal ResidenceRental Property Landlord's Name Landlord's Address Landlord's Phone Number Property Manager's Name Property Manager's Address Property Manager's Phone Number Applicant's Name Co-Applicant's name Street Address or PO Box Where do you want this bill sent? City State Zip Code Primary Phone Number Secondary Phone Number E-mail Address I agree to comply with the City's regulations regarding City water, sanitary sewer and storm sewer services. City code can be viewed by clicking here or at City Hall. I understand that I am responsible for paying the bills for City water, sanitary sewer and storm sewer services and that the water service will be terminated if the bills for these services are not paid. I understand that a lien will be imposed on the property for these services. Delinquent accounts may be sent to our collection agency. As provided for in ORS 293.231 - You are hereby notified that a collection fee of 25% will be added to your principal balance if it is assigned to our collection agency. If you move out of state and this debt is assigned to an out of state agency, the collection fee will be increased to 40%. Agree to comply with City's Regulations Agree to comply with City's Regulations Agree By selecting the "Agree" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "Agree" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. Electronic Signature Date Leave this field blank Print
