Alternate Contact Form

This Form is for a property owner to request to have a tenant receive a copy of the bill and must be submitted with a copy of the property owners drivers license. This form cannot be submitted unless a copy of your drivers license has been uploaded at the bottom of the page.

Tenant Information
Service Address
Billing Address
Owner Information

I understand, as owner of said property, that I am ultimately responsible for all unpaid bills and associated fees. I also agree to notify the water office of any change in tenancy, billing status or ownership.

I, the owner of the property listed above, agree to abide by the rules and regulations that are now in effect, or which will be adopted in the future by the Borough of Sewickley Water Authority.

I understand that a 10% penalty will be assessed on the unpaid current balance after the due date. I also understand that failure of the tenant to pay their water bill for a period of 30 days past the due date will cause the water service to be terminated. Should service be terminated, the full balance of the account plus all applicable fees is required to be paid before service is restored.

I understand that if the tenant vacates the property it is my responsibility to have the tenant removed as an alternate contact on the account..

I understand that I am responsible for the water meter and any damage done to the water meter by freezing, tampering, or breaking of the seal. I agree to pay for any damage done to the meter.

I represent that the above location is presently capable of accepting water service. I understand this application is accepted subject to availability of water at this location.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.