Leasing Agent Service Request

  • By completing this form, I am officially requesting utility services to be transferred into my name at the above indicated property address. I understand that I am fully responsible for all charges that are billed to this account starting on the “date to connect services” listed on this form. Services will remain in my name until I contact Daphne Utilities to have them discontinued or until a new tenant assumes services in their name. I also understand that by submitting this form, that I will adhere to the terms and conditions that are stated in the signed Application for Utility Services form that is currently on file with Daphne Utilities.
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