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Utility Authorization for Tenant - Millbrook residents only

Please note this form is only for property owners to complete. As a property owner, you have the opportunity to have your utility bill under the name of a designate (Tenant or Agent).

This form is to be completed for a tenant move-in, and/or a tenant move-out.

Owners Name:

Phone Number:

Email:

Service Address:

Tenants Name:

Date tenancy begins:

Date of termination of tenancy

Please sign in the box provided below using your mouse or touch screen:

Clear

I understand by submitting this form as the property owner I am responsible for any unpaid utility bills.

I understand