Landlord Application

The information below should be filled out as completely and fully as possible.

A one-time customer application fee of $20 will be billed to your account upon application approval.

An email confirmation will be sent to you once the application has been submitted at the email address provided.

Customer Information

Landlord Name *

Property Address *

Property Address Line 2

City *

State *

Zip Code *

Landlord's Address *

Landlord's Address Line 2

City *

State *

Zip Code *

Cell Phone Number *

Home Phone Number

Email Address *

Date of Birth *

Driver's License # *

Employer *

Employer Phone Number *

Riverton City Ordinance Title 14-1-16 states that an application for water service made by tenant of a property must be guaranteed in writing by the owner of a premises or his duly authorized agent. Riverton City will require that this documentation remain on file with the city for all landlord/tenants properties within the city. This is the protection of the homeowner. If the tenant becomes delinquent in his Riverton City bill the homeowner will also be notified by mail. Water is an alienable item against the homeowner’s property. Any amount left owing will be sought through means of collection. If the city is unsuccessful the property owner will be held liable t o pay the balance. I accept and agree to the above described terms and conditions of permitting the tenant of my property (at the location noted under "Property Address" above) to open a water service account.

Customer Signature: *

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