In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the https://www.modestogov.com/865/Americans-with-Disabilities-Act-ADA.
All Property Management or Real Estate Companies requesting services to be started must have this contract completed, signed by the broker of the company, and on file with the City of Modesto before services will be provided. In addition, a security deposit may be added or required in accordance with Modesto Municipal Code (MMC) 11-6.02.
All requests will be processed within forty-eight hours. Please fax completed form with attachments to the City of Modesto at 209-491-5920.
A copy of the Agent's California Driver's License and their City of Modesto Business License must accompany this request.
Complete the information below if the Real Estate Agent is managing the property for the Property Owner.
Please enter full name
Social Security Number or Tax Identification Number
If yes, customer assumes responsibility for all services bill.
I, the above listed agent, do hereby agree that in signing this document I am requesting the City of Modesto to place the utility services in my name, which include water, sewer, storm drain, and garbage, until I request in writing that services be terminated.
I understand i am responsible for payment of the services each month. If the final bill is left unpaid, it is understood I will not be allowed to have any new accounts set up until all past due balances are paid in full.
Please sign after printing
* indicates a required field