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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.
16. Legal Disclaimer
    This agreement does not relieve the property owner of account responsibility. In case of nonpayment, the property may be liened.
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field