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Landlord & Renter Duplicate Bill Setup Form

2. Landlord Name*

3. Landlord Address*

5. Landlord Phone*

7. Renter Name

8. Property Address*

10. Renter Phone

12. Account Number*

14. This form must be filled out by the property owner. If you are a renter, please contact your landlord.

    This form must be filled out by the property owner. If you are a renter, please contact your landlord.

16. Legal Disclaimer

    This agreement does not relieve the property owner of account responsibility. In case of nonpayment, the property may be liened.

    This agreement does not relieve the property owner of account responsibility. In case of nonpayment, the property may be liened.

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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field