City of Lake Mary Welcome to the City of Lake Mary, Florida. Contact Us
 
 
   

Your Ip Address: 38.107.179.214

To: Susan Baumbach
Title: Utility Billing Specialist
Phone: 407-585-1448

Lake Mary Water Application Form

City of Lake Mary
Post Office Box 950715
Lake Mary, FL 32795-0715
 

Date Effective: Select Date

Name:
Service Address:
Mailing Address:
Phone:
Work Phone:
Employer Name:
Work Address:
Drivers License State:
Drivers License #:
Spouse Name:
Water Deposit:
Irrigation Deposit:
Are you the Renter/Owner?
(Check One):
Cash CHECK
CHECK #:

I AM APPLYING FOR CITY OF LAKE MARY UTILITY SERVICE AT THE ABOVE ADDRESS. I AGREE TO FOLLOW ALL CITY RULES FOR UTILITY SERVICE AND TO PAY CHARGES IN EFFECT AT THE TIME OF DELIVERY.

I AM ALSO RESPONSIBLE FOR MAKING SURE THAT ALL FAUCETS ARE IN THE OFF POSITION BEFORE THE SERVICE IS ESTABLISHED. THE CITY IS NOT LIABLE FOR DAMAGES CAUSED BY WATER FAUCETS OR OUTLETS LEFT ON.

I UNDERSTAND THAT NON-PAYMENT OF MY ACCOUNT WILL STOP SERVICE.

Signature of Owner:
Date: 02/04/2012
Printed Name of Owner:
 
 
   
 
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