Requester Information

 
 
 
 
 
 
 

ADDRESS OF LIEN PROPERTY

 
 
 
 

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AGREEMENT

By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

Electronic Signature

 

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Terms and Conditions

NOTE: THIS SERVES AS A REQUEST FOR A STATEMENT OF OUTSTANDING WATER/SEWER CHARGES, LATE FEES, PENALTIES AND INTEREST (AS APPLICABLE) ASSOCIATED WITH THE PROPERTY LISTED ABOVE. PAYMENT IN FULL OF THE TOTAL PAY-OFF AMOUNT IS REQUIRED TO EXTINGUISH LIENS ON THE PROPERTY FOR OUTSTANDING WATER/SEWER CHARGES. PAYMENT MAY ALSO BE REQUIRED AS A CONDITION OF ESTABLISHING NEW SERVICE TO THE PROPERTY. THE PAY-OFF AMOUNT IS ONLY VALID FOR 30 DAYS FROM THE DATE OF THE STATEMENT OF CHARGES. THE CITY OF ATLANTA WILL NOT BE RESPONSIBLE FOR INCORRECT OR INCOMPLETE PAY-OFF AMOUNTS DUE TO THE FAILURE OF A REQUESTING PARTY TO PROVIDE CORRECT OR INCOMPLETE PROPERTY INFORMATION.

 

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