HomeMy WebLinkAboutRequestForService-TransferOfNewTenantREQUEST FOR SERVICE – TRANSFER TO NEW TENANT
City of Oshkosh Utilities ● 215 Church Ave, Oshkosh, WI 54901
Email: utilitybill@oshkoshwi.gov Office: (920) 232-5325
INSTRUCTIONS: This form MUST be COMPLETED in its entirety and returned to the Utility Accounting Department in order
for your request to be processed.
* Include your mailing address (if different from the serviced property address).
* Include a telephone number where you can be reached during business hours.
* Owner or Tenant Authorization is Needed (Only One)
* Service requests are for future dates only
Account Number (if known):
SERVICED PROPERTY INFORMATION (REQUIRED)
Address: City/ST/Zip:
Effective Date of Request:
PROPERTY OWNER INFORMATION
Name:
Phone:
Landline: Cell Phone:
Name 2:
Email Address:
Mailing Address (if different from Property Address):
City/ST/Zip:
TENANT/RESPONSIBLE PARTY (REQUIRED)
First M.I. Last
Name:
Phone:
Landline: Cell Phone:
Name 2:
Email:
Bill Delivery: Email Postal Mail Both
Mailing Address (if different from Property Address):
City/ST/Zip: Lease Start Date:
**PRIOR ADDRESSES IN OSHKOSH WITH WATER ACCOUNT IN YOUR NAME**
OWNER AUTHORIZATION
As the owner of the above-referenced property, I hereby authorize the City of Oshkosh to send utility bills directly to the
above-named tenant/responsible party. I understand that I will not receive a copy of the monthly bills, but I will receive
notice of any past due accounts when the tenant/responsible party is delinquent. I understand that I can call (920) 232-5325
during normal business hours to obtain account balances. I understand and acknowledge that I am ultimately responsible for
all utility charges (sewer, water, storm water, etc) for the property and that any unpaid balance as of November 15 of each
year will be placed on the tax roll and become a lien against the property.
TENANT/RESPONSIBLE PARTY AUTHORIZATION
I understand that I am responsible for the utility charges incurred at this location until I provide notice that I have moved and
am no longer responsible for this utility bill. I hereby authorize the property owner to have access to information related to
my account, including usage information.
Signature (owner or tenant): Owner Tenant
Date:
Office Use Only
Signature: