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Authority to Bill Tenant for Water/Sewer Services

  1. Enter rental unit street address (including unit number/letter)

  2. Enter property owner name

  3. Enter property owner mailing address

  4. Enter 10-digit property owner contact phone number (no spaces or dashes)

  5. HUD/Section 8 Recipient*

    Choose one

  6. *All residential rental properties must have a Rental Housing License in force at all times. If not yet registered or License is expired, please contact 410-848-2261 before submitting form.

  7. Change Billing To:*

    Choose ONE

  8. Enter name of Tenant

  9. Complete if Tenant mailing address is different than Service Location address

  10. Enter 10-digit tenant contact phone number (no spaces or dashes)

  11. By typing the Property Owner name, you electronically sign and agree to the following: "It is understood and agreed that giving the City of Westminster authority to bill tenants directly does not relieve the undersigned Property Owner from primary liability for water consumed and/or sewerage discharged from the premises at the above address. In accordance with Section 160.5.A of the City Code of Westminster, this form must be completed and returned to us before any account will be placed in the tenant’s name. Any accounts with an open final bill will become the landlord/property owner’s responsibility until these charges have been paid. It is also the landlord’s responsibility to periodically check on the status of their accounts and to notify the City when tenants move in/out in order that closing bills can be generated. Landlords will receive copies of all bills."

  12. Enter effective date for billing change request

  13. Enter date of submission

  14. PLEASE NOTE

    Effective Date must be subitted within FIVE business days PRIOR to the tenant change. Requests CANNOT be back-dated.

  15. Leave This Blank:

  16. This field is not part of the form submission.