LANDLORD CUT-IN AGREEMENT - LCU Service Request

The Landlord Cut-In Agreement should be completed before the rental process takes place. If Landlord Cut-In Agreement is not received for service, then a signed lease shall serve in lieu of the Landlord Cut-In Agreement.

Please read this agreement and fill in the requested information.

I understand that signing this agreement allows Lee County Utilities to automatically transfer the water and/or sewer service to my name if a tenant/occupant requests a disconnect or if the account is closed out due to nonpayment at a rental property listed on this agreement.
I understand that if I change any billing address, sell the property or need to add or delete properties, I must notify Lee County Utilities.

NOTE: This is not an application for water service.

Please complete the following.

Account Information

Last Name*

First Name*

Phone*

Note: Enter your Email above if you would like to receive a confirmation email

Mailing Address

Mailing Address*

Apt/Unit

City*

State*

Zip Code*

Identification

Drivers License Number*

State of Issue*

Address(es)

Please list address(es) served by a separate meter that should be automatically transferred.

Address	City	Effective Date

An electronic or manual signature is required when submitting this form. Write your name in the signature area to submit this form electronically (acceptable per Florida Statue 668.50). If an electronic signature is not possible, the form may be printed, signed and submitted in person, via FAX, or by a scanned copy sent via e-mail.

Signature*

Use your mouse or finger to draw your signature above

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