Form Center • Tenant Change Form

Utility Account

Finance Department
Tenant Change Form
All required fields are indicated with an (*).
Form must be completed by the owner, on behalf of tenants.
Account balances must be paid in full before tenant changes will be made.
Utility Account Number (required)*
Utility Service Address (required)*
Billing Change Type (required)*
Please specify who the billing needs updated to using this form.
1. Change billing into a new tenant's name
2. Change billing back into the owner's name
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Owner's Contact Information

Owners Name (required)*
Owners Mailing Address (required)*
City, State, Zip Code (required)*
Owners Email Address (required)*
Owners Phone Number (required)*
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Tenant's Contact Information

Tenant Name (required)*
Tenant Mailing Address (required)*
City, State, Zip Code (required)*
Tenant Email Address (required)*
Tenant Phone Number (required) *
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Effective Date

Effective for the following billing cycle (required)*
1. Jan services (Billed in Feb) - Form must be submitted by Jan 31
2. Feb services (Billed in Mar) - Form must be submitted by Feb 28/29
3. Mar services (Billed in Apr) - Form must be submitted by Mar 31
4. Apr services (Billed in May) - Form must be submitted by Apr 30
5. May services (Billed in June) - Form must be submitted by May 31
6. June services (Billed in July) - Form must be submitted by June 30
7. July services (Billed in Aug) - Form must be submitted by July 31
8. Aug services (Billed in Sept) - Form must be submitted by Aug 31
9. Sept services (Billed in Oct) - Form must be submitted by Sept 30
10. Oct services (Billed in Nov) - Form must be submitted by Oct 31
11. Nov services (Billed in Dec) - Form must be submitted by Nov 30
12. Dec services (Billed in Jan) - Form must be submitted by Dec 31
Pursuant to the Telluride Municipal Code Sec. 13-2-120, should the above tenant/renter and/or management company fail to pay all, or part, of the utility charges incurred while occupying the premises, I, the owner of the property, hereby understand, acknowledge and accept full liability of such charges and any and all fees and penalties associated with the collection of such charges. I further acknowledge that all unpaid utility charges shall cause a lien on my property filed with the San Miguel County Clerk’s office and shall not be released until all charges are paid in full. The Town of Telluride agrees to notify the tenant/renter and/or Management Company and the owner of the property should the utility charges become delinquent. Payment in full should be received within thirty (30) days after such notice in order to avoid collection action, such as water shut-off and/or the filing of the property lien by the Town of Telluride. The Town of Telluride will not pro-rate any billing statements between tenant/renter and/or property management company and the owner.
Current balance due (required)*
We will not change the account into a new tenants name until the account balance has been paid in full.
Electronic Signature Agreement (required)*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree
Print Name (required)*
Electronic Signature (required)*
I, the legal owner of the above mentioned property, do hereby accept these terms and conditions and agree to notify the Town of Telluride Finance Department in writing of any changes.
Date (required)*
Date (required)

Leave This Blank:

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

This field is not part of the form submission.
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