Fillable Printable Open Account Authorization Letter

Open Account Authorization Letter

City of Plantation  Utilities Department

400 NW 73rd Avenue, Plantation, FL 33317

(T) 954-797-2290  (F) 954-797-2720

Plantation.org

LETTER

AUTHORIZATION

The undersigned property owner/tenant hereby acknowledges that Mr./Mrs./Ms__________________________

is to act on my behalf in all manners relating to my application for a new utilities account for the premises

located at ___________________________________ in Plantation, Florida effective _________________. My

signature below indicates my acknowledgment that I have read the foregoing, or that it has been read to me, and

that I understand and do not object to Mr./Mrs./Ms. _____________________________ applying on my behalf

and receiving Utility Service under my name from the City of Plantation at the above referenced property,

which I own/rent.

I understand that for services to begin an agreement between the City of Plantation and I, which outlines the

rules, regulations, and ordinances of the Utilities Department, is to be submitted signed and notarized along

with this Letter of Authorization.

________________________________________ _______________________________________

Property Owner/Tenant, Printed Name Property Owner/Tenant, Telephone

________________________________________ _______________________________________

Property Owner/Tenant, Street Address Property Owner/Tenant, Email Address

________________________________________

Property Owner/Tenant, City State Zip

________________________________________ ____________________

Property Owner/Tenant, Signature Date

State of Florida

County of Broward

The foregoing instrument was acknowledged before me this ______ day of ____________________, 20_____,

by ____________________________________ who is personally known to me or who has produced a

______________________________ as identification, and ___who did (___did not) take an oath.

_________________________________ Seal

Notary Public, Signature