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New Customer Application

CONTRACT FOR WATER SERVICES with the
HOMOSASSA SPECIAL WATER DISTRICT
P.O. Box 195
HOMOSASSA, FL 34487-0195
PH: (352)628-3740
Email: hswd@tampabay.rr.com

Required fields are marked by *.

*Phone #: Business Phone #:
*Name: ('Consumer'), Owner Renter
*Service Address: Lot: Block:
Billing Address:
City: State: Zip Code: *Email:
*SS#/Taxpayer ID #: *D.O.B.: *Drivers License #:

hereby makes application to the HOMOSASSA SPECIAL WATER DISTRICT, ('HSWD'), for Water Service on said property, and agrees to pay current rate for Meter Installation/Service Deposit, receipt whereof is hereby acknowledged. This meter installation charge is not returnable. Consumer further agrees to pay, in addition thereto, regular monthly bills based upon meter readings, at rates fixed by HSWD. In consideration of said payment and promises, HSWD, agrees to furnish water service to above described property.

RULES AND REGULATIONS OF HOMOSASSA SPECIAL WATER DISTRICT

1. The Service Meter remains property of HSWD and is not to be tampered with or damaged by Consumer. If District property is tampered with, tampering fees will be assessed to the account.

2. Bills are mailed ordinarily on the 1st day of each month and are due upon receipt. If payment is not received at HSWD office by the close of business on the 25th day of the month, then on the 26th day of the month the account is delinquent, a LATE PAYMENT FEE is is assessed and a late notice is mailed. If payment is not received at HSWD office by the close of business on the 7th day of the following month, service will be discontinued on the 8th day without additional notice and a NON-PAYMENT FEE will be assessed. Thereafter, for restoration of service, Consumer must pay the delinquent water bill, the late fee and the non-payment fee. Each additional time a shut off for non-payment occurs in a 12 month period following the first shutoff, an additional deposit will be required. Deposits will be refunded after a 12 month period of no late charges. HSWD bills monthly and cannot be held responsible for bills lost in the mail. If Consumer has not received a bill by the 15th day of each month, consumer should call the HSWD office.

3. A deposit in the amount of Seventy Five Dollars ($75.00) guaranteeing payment of the bill will be required for each residential Consumer. A deposit of One Hundred Twenty Five Dollars ($125.00) or 2 times the average bill over the last 12 months, whichever is greater, will be required for each commercial Consumer.

4. Consumer agrees to hold harmless HSWD for any failure of water service due to acts of God or breakdowns of a nature common to such operations and services, and to guard and protect installed meters against damage and destruction other than that caused by normal wear and usage.

5. The meter and service contracted for herein must begin and be installed within one (1) year of execution of this agreement. Consumer will be responsible for any meter charge increase.

6. Attorney's Fees: In any action to enforce the terms and conditions of this Agreement, the prevailing party shall be entitled to recover from the losing party all costs and expenses, including attorney's fees, incurred in the enforcement action, including appeals.

I ACKNOWLEDGE THAT I HAVE READ THE HSWD RULES AND REGULATIONS AND UNDERSTAND SAME.
*Signature of Consumer:

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