Service Address(Required) Wood Village, OR 97060 Account Number(Required) Effective Date (mm/dd/yyyy)(Required)Service Stop Date can only be Monday through Friday Month Day Year Reason for Form(Required)Please SelectMove OutOtherExplanation Name on Account(Required) First and Last Forwarding Address(Required)Your final bill will be sent here. Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Are you...?(Required)Please SelectRenterSellerProperty ManagementProperty OwnerLandlord's Name(Required) First Last Will this property be a new rental home?(Required) Yes No If this property has not been rented before, you will be receiving an annual rental license invoice from the City per WVMC 5.20. As the Property Manager/Owner, you are legally responsible, per WVMC 13.04 and 13.12, for the payment of all utility fees associated with this property in instances of tenant non-payment and utility liens.Phone(Required)Email Enter Email Confirm Email AgreeBy selecting the "Agree" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "Agree" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. I agree to comply with the City's regulations regarding City water, sanitary sewer and storm sewer services. City code can be viewed online at woodvillage.municipal.codes or at City Hall. I understand that I am responsible for paying the bills for City water, sanitary sewer and storm sewer services and that the water service will be terminated if the bills for these services are not paid. I understand that a lien will be imposed on the property for these services. Delinquent accounts may be sent to our collection agency. As provided for in ORS 293.231 - You are hereby notified that a collection fee of 25% will be added to your principal balance if it is assigned to our collection agency. If you move out of state and this debt is assigned to an out of state agency, the collection fee will be increased to 40%.Electronic Signature (Full Name)(Required) Date (mm/dd/yyyy) Month Day Year CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
