Application For Water Service

New Account

Requested Date Service is to be Transferred into your name: (NOTE this may take a min of 24hrs to be completed)*

Date

Date Applied:

Date

Will this account be in more than one persons name?*

Name:*

Additional Name:

Is your Billing address different from your Service Address?*

Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Billing Address: (If Different From Service Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone:

Cell Phone:*

Work Phone:

Email address:*

example@example.com

Drivers License #:*

Deposit Paid:

CHOOSE FROM THE FOLLOWING;*

Landlord’s name:

Landlord’s phone number:

Area CodePhone Number

Do you have an emergency contact in case of emergency (i.e., water main break, leak in service line, etc.) if you are unavailable: *

NAME of person who doesn’t live with you to contact in case of emergency (i.e., water main break, leak in service line, etc.) if you are unavailable:

ADDRESS of person who doesn’t live with you to contact in case of emergency (i.e., water main break, leak in service line, etc.) if you are unavailable:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PHONE NUMBER of person who doesn’t live with you to contact in case of emergency (i.e., water main break, leak in service line, etc.) if you are unavailable:

Area CodePhone Number

RELATIONSHIP of person who doesn’t live with you to contact in case of emergency (i.e., water main break, leak in service line, etc.) if you are unavailable:

A deposit of $60.00 is required on all new customers and a $20.00 Connection/Turn On Charge (if during normal business hours). The deposit is held for 12 months, and if your bill is not delinquent any time during that period, the deposit is credited back to your account with interest at the current bank rate.

TERMS: We read meters and bill all accounts monthly. Your water bill is due and payable upon receipt. You forfeit your discount if not paid in full by the due date noted on the bill each month. If there is a previous unpaid balance on any billing, your account is considered delinquent and subject to disconnect. If your water service is disconnected, there will be a reconnect fee added to your past due amount. All past due amounts and fees must be paid before water service can be reinstated.

There is a fee for all returned checks.

The above applicant herein called “USER” and the Oldham County Water District, hereinafter called “SUPPLIER” that: WHEREAS the USER desires to purchase water from the SUPPLIER, the USER hereby enters into this Service Contract as required by the SUPPLIER.

NOW THEREFORE, in consideration of the mutual covenants, promises and agreements herein contained, it is hereby understood and agreed by the parties hereto as follows:

SECTION 1. The SUPPLIER shall furnish, subject to the limitation set out in its Bylaws, Rules and Regulations and Tariffs now in force or as hereafter duly and legally supplemented, amended, or changed, such quantity of water as USER may desire in connection with the property to be served by this agreement.

SECTION 2. The USER agrees to comply with and be bound by the Bylaws, Rules and Regulations, and Tariffs now in force or as hereafter duly and legally supplemented, amended, or changed. The USER agrees to pay for water at such rates, time, and place as shall be determined by the SUPPLIER, and agrees to the imposition of such penalties for non-compliance as set out in the Supplier’s Bylaws. Rules and Regulations and tariffs now in force or as hereafter duly and legally supplemented, amended or changed. It is understood and agreed that the SUPPLIER reserves the right to determine the size of service connection to be used to supply water to the USER. A 5/8” x ¾” meter will be the standard meter used. If a USER contracts for a larger meter, the USER agrees to pay the actual costs of materials and labor for the installation of such a meter. Unless under special circumstances requiring the approval of the utility’s commissioners, a separate meter must be installed by the SUPPLIER for each individual residence or place of use. The location of the water meter on the property will be determined by the SUPPLIER and will not be more than fifty (50) feet from the main, unless special circumstances exist. The SUPPLIER shall purchase and install a cutoff valve and a water meter and other appurtenances thereof. The SUPPLIER shall have exclusive right to use said cutoff valve and water meter.

SECTION 3. The USER shall install and maintain, at his/her own expense, a service line that shall begin at the meter and extend to the dwelling or place of use. The USER shall connect his service line to the water distribution system and shall commence to use water from the system on the date the water is available. Water charges to the USER will commence on the date service is made available by the SUPPLIER, regardless of whether or not the USER is connected to the system, or is in fact using water from the system. The failure of the USER to pay water charges duly imposed shall result in the automatic imposition of the penalties as set out in the Supplier’s approved Tariff. Penalties shall include, but not be limited to, a late payment penalty charge, termination of service and a reconnection fee.

SECTION 4. The SUPPLIER shall determine the allocation of water to the USER in the event of a water shortage, and may shut off water to the USER if such event occurs. The SUPPLIER may shut off water to the USER if the USER allows connection of extension to be made to his service line for the purpose of supplying water to another party. In the event the total water supply shall be insufficient to meet all the needs of the USER, or in the event there is a shortage of water, the SUPPLIER must first satisfy all the needs of all the USERS for domestic purposes before supplying any water for livestock purposes and must satisfy all of the needs of all the USERS for domestic and livestock purposes before supplying any water for garden or other purposes.

SECTION 5. The USER agrees that no present or future source of water will be connected to any water lines served by the SUPPLIER’s water lines and will disconnect from his present water supply, well, or other source, prior to connection to and switching to the SUPPLIER’s system and shall eliminate present or future cross-connections in his system.

Please verify that you are human*

SIGNATURE*

TYPE THE NAME OF THE SIGNATURE:*

Today Date:*

Date

Once we receive your application, our Customer Service Team will contact you to arrange payment of the deposit and Connection/Turn On Charge (if during normal business hours) or you may call the office during normal business hours.

Thank You and have a great day

Call us at 502-222-1690 or drop by the office at 2160 Spencer Ct, LaGrange, KY Office hours are 8:00 A.M. to 4 P.M. Monday-Friday