Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
The following form may request personally identifiable or protected health information. Please see our Privacy Policy for details. This form is encrypted. SSL is on to ensure a higher level of security. A recaptcha must be completed before submission, you cannot save progress, and you cannot receive an email copy of the form.

Landlord Agreement

  1. City of Vermillion Logo
  2. Terms of the Landlord Agreement

    This Landlord Agreement is available to all persons offering residential space for rent in Vermillion. With the high occupancy turnover in Vermillion, it frequently happens that tenants whose utility accounts are in their names advise the City Finance Office that they are vacating and instruct staff to read the meter and terminate service. There is no choice but to follow their instructions. Realizing that this creates a risk for you (especially in cold weather), the City offers you the Landlord Agreement. This service allows you to direct Staff to automatically transfer the account to your name with the understanding that the City does not assume the responsibility of liability for consequences following the City's failure, if that should happen, to leave service on at the property. Each time service is transferred to your name, you will be charged the normal service connection fee of $10.00 plus tax for electric service and/or $10.00 for water service. Connection fees not paid at the time of transfer will be added to the monthly account billing. Service fees that are not paid in a timely manner will result in termination of this agreement. If the service is transferred to your name, you will be responsible for payment of the utility service until you notify Finance Office Staff that you would like the service discontinued or a new tenant assumes responsibility for the service. For the new tenant to assume responsibility for the service, it is necessary for the tenant to complete a Utility Service Application and pay the utility deposit and service fees. A telephone call from you or the new tenant will not transfer the responsibility to the new tenant. NOTE: For your protection, you should contact the Finance Office to ensure the new tenant has transferred and assumed responsibility for utility service. If you want service transferred to your name, in case of a vacancy under these circumstances, please complete and submit this Landlord Agreement.

  3. SSN, Driver License Number, or Federal ID.

  4. If you desire all apartments in a particular apartment building included, please indicate this clearly. Otherwise, all units will be considered separately and the service will be performed at only those units specifically designated. It will be necessary for you to advise the Finance Office in writing of changes you may desire in the future, and the City will continue to follow your instructions until you notify the Finance Office to the contrary.

  5. Authorization for Landlord Agreement*

    Under the circumstances and pursuant to the terms and conditions of this Landlord Agreement, I advise you that I desire continued service at the above listed rental facilities which I own or manage. I also understand that you are volunteering this service and do not assume responsibility of liability for consequences following the City's failure, if that should happen, to leave service on at the premises in the event of vacation by any tenant ordering discontinuance of service. I understand that I must provide written notice for any additions or deletions of properties to this agreement.

  6. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  7. FOR OFFICE USE ONLY

    Date Received:                                        Received By:                                       Date Entered:                                       

  8. Leave This Blank: