Home Public Works Rates & Billing Designation of Tenant / Agent Form

Designation of Tenant / Agent Form

In order to set up your account for the tenant to receive a copy of the statement the owner of the property must:

Complete and sign the Designation of Agent/Tenant pdf form below and submit it to our office

Designation of Agent/Tenant Form (pdf) or fill out online form below and submit.

APN (no dashes)

As the owner of (type in property address)

Account No.

Tenant

Tenant Name

Tenant Mailing Address

City

State

Zip

Tenant Phone Number

Tenant Email Address

Date of Move-In (Note: IVGID will not prorate charges)

Agent* (if blank Owner will receive copy of statement)

Agent Name

Agent Mailing Address

City

State

Zip

Agent Phone Number

Agent Email Address

*Owner, or agent assigned above, will receive a copy of the statement by mail or may sign up for paperless statements through online account access.

I understand that correspondence may only be sent to my tenant/agent’s mailing address.

I acknowledge that all charges, fees and amounts due and payable shall be billed to the owner of the premises,

whether or not the owner is also the occupant.

The District will not prorate charges on account upon transfer of tenant.

Base charges on the account are billed in advance and consumption charges are billed in arrears.

With this designation I am not waiving the District’s right to collect for service from me as the owner of the property served.

Signature (type your name) of Owner or Agent (if Designation of Agent on file)

Date

Print Owner's Name

Owner's Mailing Address

City

State

Zip

Owner's Phone Number

Owner's Email Address

Please enter the word you see in the image below:

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