Public Works Department 200 S. Ivystreet Telephone (541) 774-2140

CITY OF MEDFORD

PUBLIC WORKS DEPARTMENT 200 S. IVYSTREET TELEPHONE (541) 774-2140

UTILITY BILLING MEDFORD, OREGON 97501 FAX (541) 774-2552

OWNER REQUEST FOR TENANT BILLING

As the property owner, all charges for City Utility services are your responsibility (per Medford Municipal Code 4.1201) whether or not the account is in your name.

By completing this form you are requesting the bill be sent to all tenants of this property and understand that you are fully responsible for any balance not paid by any tenant.

You may call our billing office to check the status of your account. In July of each year, owners are notified of accounts with past due sewer balances that will be certified for collection on the property tax bill if not brought current. Amounts certified will include any late charges incurred (3% of the outstanding balance, $3 minimum, each month) plus a 10% ($10 minimum) administrative fee. Other unpaid utility fees will be referred to a collection agency under the tenant’s name. If the collection agency is unable to collect, the utility account will be put in the owner’s name for future charges.

While I remain responsible for payment of City Utility services, I would like it to be sent to:

A property management service:

Name:
Mailing Address: / Phone:

Your tenants (current and any future tenants, unless notified by owner):

Name:
Mailing Address: / Phone:

I do not own the property:

New Owner’s Name:
Title Company: / Date of Sale:
Comments:

APPROVAL:

Owner’s Name: / Phone:
Service Address of Property:
Project #: / Location:
Owner’s Mailing Address:
Property Management:
**Please note: If this form is completed by a property manager, by signing you are stating that property owners have given you authority over such matters.
Print Your Name: / Sign: / Date:

Complete, sign and mail or fax the original to City of Medford Utilities at the above address.

Retain “copy” for your records.