Voluntary Water Metering Program Application

Account Information Service Street Address:
Utility Account Number:

Property Owner Name:
Phone Number:
Email Address:

Tenant Information (if applicable) Name:
Phone Number:

Acknowledgement

I hereby acknowledge that by submitting this form I am electing to participate in the Voluntary Metering Program and cannot return to the flat rate structure as per BMC15.08.040 (F). I have read this application and state the information is correct, and agree to comply with all City of Bellingham ordinances and Washington State laws regulating activities covered by this permit application.

Signature:
(Please type your complete name)
Date: