643 Quince Street, Mendota, CA 93640 2025

1. Click ‘Get Form’ to open the document in the editor.
2. Begin by entering your Account Number in the designated field at the top of the form.
3. Fill in the Date of Deposit and the Dates On and Off as required. Ensure these dates are accurate for processing.
4. Input the Deposit Amount of $150.00 in the appropriate section.
5. Complete the Route/Service No. field and provide your Name along with any relevant account status (Not Paid or Paid).
6. Enter both Service Address and Mailing Address clearly to avoid any service interruptions.
7. Provide personal details such as Telephone, Date of Birth, Social Security No., Driver's License No., and California ID No. as applicable.
8. If applicable, fill in information regarding your spouse, nearest relative, and employer details.
9. Review all fields for accuracy before signing as either Renter or Owner at the bottom of the form.

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