Utility Billing Directive Form

City of Meridian - Utility Billing Directive Form

Fields marked with * are required.

Account # * (Format: XXXXXXXX-XX)

Address Tenant Occupying - Street

Address Tenant Occupying - City

Address Tenant Occupying - State

Address Tenant Occupying - Zip Code

Move In Date *

The Property Owner/Manager of the above described property and account, does hereby instruct the Meridian Utility Billing Services (MUBS) to prepare the monthly billing statement for the necessary services to the above referenced address in the following tenant name(s) and relinquish my/our authority to terminate services to property while occupied by the tenant.

Tenant Name(s) * - (List all tenants on lease!)

Tenant Phone # *

I do hereby acknowledge that I will remain responsible for any unpaid account balance for water services, sewer services, and garbage collection services provided to the Service Address by the City of Meridian. If the Tenant accrues a delinquent or overdue balance, or moves out and leaves a balance of any size, I understand that I, the undersigned, will be responsible for payment in full to the City of Meridian of the amount due. *

I will ensure that all balances due prior to the Tenant’s move-in are paid in full and understand that any unpaid balances can/will result in service disconnection. I also understand that the Tenant will be directed to contact me should the utilities be terminated due to non-payment of services prior to the move-in date. *

I understand that the utility billing account for the Service Address will remain in the name of the Property Owner, but will be sent to the Tenant listed above. I will notify the City of Meridian Utility Billing Department (MUBS) when the Tenant vacates the Service Address and request a final reading of the water meter. *

I acknowledge that when this Billing Directive is in place, I will not receive monthly statements for water services, sewer services, and garbage collection services provided to this Service Address. If the account becomes delinquent, I will be sent a copy of each delinquency notice that is sent to the tenant. I further agree that any overdue balance may result in: 1) termination of water or sewer service to the Service Address, 2) reporting that outstanding amount to the Ada County Assessor for collection as a special assessment on the property tax bill for the Service Address, 3) recording of a lien on the real property at the Service Address, 4) reporting of the account to collections, resulting in a report of the delinquency to credit bureaus, and/or 5) any additional applicable civil or criminal penalties. *

MUBS is authorized to release any information requested about this account to the Tenant during their tenancy at the Service Address. The information released may be, but is not limited to: account balance, payment history, and delinquency status. *

I do hereby certify that I am the owner or the duly authorized agent to make this request for the owner of the subject property receiving the service. By signing below, I further acknowledge that I have read, understand, and agree to the Terms and Conditions set forth above.

Who is filling out this form? *

Owner Property Manager

Owner Name *

Owner Phone # *

Owner Email Address

Owner Billing Address - Street *

Owner Billing Address - City *

Owner Billing Address - State *

Owner Billing Address - Zip Code *

Driver's License or Other Govt. Issued ID# *

Issuing Agency * (Idaho DL, Military ID, Etc)

TERMS OF ACCEPTANCE and SIGNATURE I, the Owner/Property Manager for this Billing Directive, warrant the truthfulness of the information provided in this application.

Electronic Signature * (Please type your First and Last Name)

Acceptance Checkbox *
I understand that by signing this document I acknowledge and agree to the above Terms of Acceptance.

Please review the above document prior to submission. You are electronically signing this document stating that the information provided is true and correct. In some instances we have seen auto fill alter the valid requested information. Forms with invalid information can not be used.

Utility Billing Forms

City of Meridian - Utility Billing Directive Form