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2. Submission Instructions

   All Property Management companies requesting utility services must have this contract completed, signed by the representative, and on file with the City of Modesto to activate service. Please provide the following items:

4. Required Items*

   1. Completed City of Modesto Property Management Contract signed by the representative of the company;
   2. Copy of your business license with the City of Modesto;
   3. Copy of the management agreement between the property owner and management company

6. In addition, a security deposit may be required in accordance with MMC 11-6.02.  All requests will be processed within 48 hours from time of receipt. Please fax completed form to the City of Modesto at (209) 491-5920. 

   *WHEN SERVICE IS NO LONGER NEEDED, WRITTEN REQUEST TO TERMINATE SERVICE IS REQUIRED. *

10. Name of Property Management Company*
11. Property Owner *
13. Property Management Company Tax ID Number*
14. Property Owner's Identification*
    Please enter one of the following: Driver's License Number, or Tax ID Number.
16. Billing Address*
17. Service Address*
19. Phone Number*
20. Fax Number
22. Does the owner need to receive a copy of the bill?*

    1. Yes
    2. No
24. Street Address*
26. City*
27. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
28. Zip Code*
30. We, the above listed property management company, do hereby agree that in signing this document we are requesting the City of Modesto to place the utility services in our name (water, sewer, storm drain and garbage) until we request in writing that services be terminated. We understand we are responsible for payment of the services each month. If the final bill is left unpaid, it is understood we will not be allowed to have any new accounts set up until all past due balances are paid in full.
32. Responsible Party Signature
33. Date
34. Account Number
36. Are garbage cans at the property? (We do not bill for garbage for multi-family properties or County areas)

    1. Black
    2. Green
    3. Blue
    4. No Can
    5. Not Sure
38. Please select from the following:*

    1. Start Service
    2. Stop Service
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