Required fields are marked with asterisks (*)

Northern Maple Utilities Inc. Landlord Form:

For landlords to give their tenants authorization to view and pay their Water/Sewer account in the towns of Drayton and Moorefield.

Water/Sewer Account # (If known):

Tenanted Property Address:

Owner Name(s):

Owner Phone #:

Owner Email:

I hereby give authorization for my tenant(s) to view and pay the water/sewer account at my property. I request the water/sewer bills to be addressed to:

Tenant Name(s):

Tenant Phone Number(s):

Tenant Email(s):

Effective Date:

I/We acknowledge that as the property owner(s), I/we, am/are responsible for these charges should the tenant default on payment and that unpaid monies will be added to the property tax roll.

Owner Signature:

Clear

Date: