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2. Name*
4. Ownership*
   -- Select One --OwnerTenant
6. Email Address*
8. Please note: The City of Margate is a public entity subject to Chapter 119 of the Florida Statutes concerning public records. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. All e-mail messages sent and received are captured by our server and retained as public records.
10. Service Address*
12. Utility Account*
14. Drivers License*
    Drivers License number must match the account holder
16. Utility bills are due upon receipt and become past due 20 days after the statement date. Failure to receive a bill does not prevent service interruption or additional charges.
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field