BY SIGNING BELOW YOU AGREE TO THE FOLLOWING
The undersigned applicant for residential water/sewer/garbage service states that the information provided in this application for city utilities is true and accurate to the best of applicant's knowledge. Applicant also understands that all charges are due as billed and accepts total responsibility for payment of all charges incurred for the services provided, including reasonable attorney's fees and costs incurred for collection of the unpaid balance.
Furthermore, the undersigned applicant consents that water services provided at the location listed may be turned on without applicant or applicant's representatives present. Applicant further agrees to hold the City of Panama City and its employees HARMLESS should the property, building(s) or premises incur damage as a result of water connection.