Utilities landlord agreement form

Please attach a copy of your photo ID(Required)

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Max. file size: 100 MB.

A photo ID attachment is required for each household member over the age of 18..

Please check one of the following

When tenant notifies the City of Nixa Utilities of move out, TURN OFF water & electric services.

When tenant notifies the City of Nixa Utilities of move out, LEAVE WATER & ELECTRIC SERVICES ON and begin billing me for those services as of that date.

Please list all rental property below and note the type of property (duplex, patio home, apartment, house, mobile home & business)

**For new landlords: Effective date of service

Property Owner’s Name

Property Owner’s Signature

Owner’s Phone Number:

Management Company (if applicable)

Contact Person (if other than owner)

Contact Phone Number

Contact Email Address

Bill to Name and Address

Date

PLEASE CONTACT THE CITY OF NIXA PLANNING AND ZONING DEPARTMENT AT 417-725-7143 FOR RENTAL INSPECTIONS PRIOR TO TENANT OCCUPANCY

Phone

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52259