City of Bloomington Utilities

Special Read Agreement

Customer Service Office Contact Information

Operating Hours	8:00 am to 5:00 pm M-F
Address	600 E Miller Dr Bloomington IN 47401
Phone Number	(812) 349-3930
Email Address	utilities.cs@bloomington.in.gov

* Field is Required

City of Bloomington Utilities Account Number

Anytime a current customer moves from

St Num

St Dir.

Street Name/Unit

I authorize City of Bloomington Utilities (CBU) to transfer the water/sewer service into the name of:

First Name

Middle Name

Last Name

Customer Name

Email Address

Telephone Number

Mailing Address

City

State

ZIP Code

The owner is

First Name

Last Name

Title

I, (or the firm I represent) acknowledge that I, (or the firm I represent) will be responsible for all water/sewer bills incurred for the property when service has been transferred according to this agreement, regardless of the amount of the bill. I agree to notify CBU if the property changes ownership or if the agreement should be voided for any reason.

I understand and acknowledge that this agreement will be voided if the landowner or property manager asks to have the water/sewer turned off at any time, and that a reconnection fee would be charged if the water/sewer is turned back on.

I affirm that the information contained herein, including attachment(s), is complete and accurate.

Click if you Agree