Office Use Only:
Acct#:	 Date of Acct Svc: 	                     Plat: Lot Block         
Application Approved  	 Denied (Reason) 	

ID verified  	

ST. LUCIE WEST SERVICES DISTRICT (SLWSD)
Application for Utility Services
Applicant is required to provide the following documentation with application:
Completed Acknowledgement and Release of Liability form
Personal ID such as a driver’s license of applicant or legal representative;
Copy of legal proof of ownership or other interest in or to the property;
o If applicant is an authorized representative, proof of legal representation;
Water and wastewater connection fees are required to be paid in full prior to any new connection. If a commercial account changes the original use there may be additional connection fees required.
Commercial account changes must be reported by the applicant to the District Manager prior to the submission of the application for service. Per SLWSD Rules Section 36 & Schedule B. (copies available upon request)
Complete the following information to open an account. (PLEASE PRINT)
Check one:	Owner	Tenant	Property Manager	If other, please indicate: 	
Utility Service Address	(Only Print Street Address)
																															
Applicant’s Name: Only print one name as shown on individual’s identification. For Business: print business name as shown on legal documentation. This is the primary account holder (Owner of property or legal representative responsible for the service location.)

(The security deposit placed on this account will be credited only to the above applicant and is non-transferable)
Mailing Address of Applicant or Legal Representative
																												
City	State	Zip
				
If requesting an email (E-bills) instead of paper bills please enter email below
TEL #		E-bills		
Alternate Contact Name (if applicable): Alternate person to be contacted by or to contact SLWSD and to pay bills on the account.
																												
Alternate Contact Phone# (if applicable)_ 	_
Agent Name (if applicable): Person authorized to make decisions for the account. Submit proof of legal representation and id
																												
Agent Phone# (if applicable)  	

Business / Commercial	Enter TAX ID#	
What type of commercial use? 	( Businesses may be subject to additional connection fees)	

Applicant shall be responsible for rendering all required deposits and other fees and charges in accordance with the Rules of the SLWSD prior to the SLWSD rendering service. Every new account requires a deposit based on the meter size for the service location. The deposit is neither negotiable nor transferable. Statements are monthly and payments are due by the due date every month regardless whether service is being used. Past due bills are subject  to a 10% penalty and/or discontinuation of service. Failure to receive a bill does not waive the penalty. The owner of the property at the service location is responsible for all outstanding account balances. The SLWSD may withhold service to a consumer who makes application for service at or upon a location for which prior service has not been paid in full to the date of such application. Should any account balance become past due after the final settlement  of that account, the outstanding account balance shall be applied to the next consumer’s account for that service location, and may result in service being terminated if not paid within twenty (20) calendar days of the date of the SLWSD written notice of the outstanding account balance. If this date falls on a weekend or SLWSD holiday, then the due date shall be the next business day.
All properties serviced by SLWSD are required to pay a minimum monthly base rate in addition to usage charges. The SLWSD’s rate schedules impose monthly water and wastewater base facility charges upon each service connection so that every month, the SLWSD bills its consumers for base facility charges plus charges for actual consumption. Therefore, even if a consumer has no measurable metered water usage during a given month, the SLWSD nonetheless bills the consumer for the monthly base facility charges. Irrigation service charges are also billed monthly on a fixed rate; however, because irrigation service is not metered, the consumer is not charged extra for usage. Base facility charges for water and wastewater may be found in Schedule A to the Rules of the SLWSD, and fixed charges for irrigation service may be found in Schedule D.
By signing the application, I understand and agree to abide by the Rules of the SLWSD. I also understand that this application will not be processed if the application is incomplete. Applications will be deemed incomplete if the applicant fails to submit any required information, documentation, deposits, and other applicable charges. One business days’ notice is required to process this application.
Applicant Signature:	Date:  	

Applicant must complete Acknowledgement and Release of Liability form. Acknowledgement and Release of Liability form is available for printing at the following link: http://www.slwsd.org/newaccnts&billing.htm.

450 S.W. Utility Drive  ●  Port St Lucie, FL 34986  ●  Office (772) 340-0220 ●  Fax  (772) 871-5771	Updated 01-8-18