Moon Township Municipal Authority 1700 Beaver Grade Road, Suite 200 Moon Township, PA 15108-3193 Phone: 412-264-4300 * Fax: 412-262-9482 APPLICATION FOR RENTAL PROPERTY - Page 1 of 2 pages Please Print, Complete Information & Fax Back to Fax Number Shown Above

Name:_______________________________________         Account No._____________________________ Service Address: ___________________________________________________________________________ Bill To Address: _____________________________________________________________________________ City, State & Zip: ___________________________________________________________________________ Telephone Number (1): ______________________ Telephone Number (2): _________________________ Date: ________________________________ Please complete owner information (if different from information above). Owner Name:________________________________________________________________ Owner Address: ______________________________________________________________ Owner City, State & Zip:_______________________________________________________ Owner Telephone No:_________________________________________________________

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