Application for Water Service

I acknowledge and understand that if I supply a utility letter of credit (electric, natural gas, water supplier, etc) at the time of your application, we can waive the deposit fees and charge only the account setup fees. The letter of credit from your previous utility supplier should indicate that you have had 12 months of consecutive good payment history with that supplier. Otherwise, the deposit fees plus setup fees would need to be paid at time of application.
Signed:

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Application for Water Service
Date Service Requested *

Month Day Year
Date
First Name *
Middle Initial
Last Name *
Email *
example@example.com
* Security Deposit can be waived with company approved Letter of Credit

** Combined Line Charge & Meter Charge as shown on the approved Rate Tariff

Advance to Construction (A.T.C.): Each advance in aid of construction for a service line or meter shall be repaid by the utility by an annual credit of one-tenth of the amount received. Said credit to be applied upon the water bill in August of each year until fully paid, and said credit to commence the month of August for all such advances received during the preceding calendar year. ATC shall stay with the home and balance is not refundable upon sale

Security Deposit: Residential security deposits shall be refunded after twelve (12) months of service with NO DELINQUENCY. The company may re-establish the deposit if the customer is delinquent three or more times within a twelve-month period. Any deposit still on file when service is disconnected will be first credited to any unpaid amounts and any amount due will be mailed within 30 days after date of final bill to customer's last known address. Bills which are not fully covered by the deposit will be billed to customer.

Establishment Fee: Is specified in the utility's tariff to cover the cost of establishing a new account and are non-refundable.

I also understand that if a water main exists on an easement that lies across my property, I must allow Chino Meadows II Water Company open and uninhibited access to that area at all times.

All lots have an 8' Utility Easement adjacent to lot lines not abutting street right of way. Customer is responsible for keeping easements clean of all debris at all times.

BILLS ARE DUE AND PAYABLE ON THE 15TH DAY OF THE MONTH. ANY AMOUNT NOT RECEIVED WITHIN 15th DAYS WILL BE CONSIDERED DELINQUENT AND SUBJECT TO THE UTILITY'S TERMINATION PROCEDURE.

I have read and fully understand the information above:
Applicant Signature *

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Date *

Month Day Year
Date
Co Applicant Signature

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Date

Month Day Year
Date

APPLICANT
Service Address *
Physical Address Where Water Service Is Required
First Name
Middle Initial
Last Name
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Cell Phone *
Emergency Phone
Social Security Number
Date of Birth *

Month Day Year
Date
Drivers License #
Employer
Work Phone
Please enter a valid phone number.
Co-Applicant
Co-Applicant Name

First Name Middle Initial Last Name
Co-Applicant Social Security Number
Co-Applicant Date of Birth

Month Day Year
Date
Co-Applicant Drivers License #
Co-Applicant Employer
Co-Applicant Work Phone
Please enter a valid phone number.
Size of Home
# of Occupants
Pool On Premise

Yes No
Own Home or Renting *

Owner Renter
Landlord's Name

First Name Last Name
Landlord's Phone Number
Please enter a valid phone number.
I/We hereby apply for water service at the address above under the terms and conditions as approved by the Arizona Corporation Commission and agree to pay for the same at the approved rates.
Applicant Signature *

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Date *

Month Day Year
Date
Co Applicant Signature

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Date

Month Day Year
Date

ARIZONA CORPORATION COMMISSION

Rules & Regulations for Easements and Rights-of-Way

The following is very important to the safety and welfare of your family as well as our employees. These rules must be complied with at all times.

1. Each customer shall grant adequate easement and right-of-way satisfactory to the utility to ensure that customer's proper service connection. Failure on the part of the customer to grant adequate easement and right-of-way shall be grounds for the utility to refuse service.

2. When a utility discovers that a customer or his agent is performing work or has constructed facilities adjacent to or within an easement or right-of-way and such work, construction or facility poses a hazard or is in violation of federal, state or local laws, ordinances, statutes, rules or regulations, or significantly interfered with the utility's access to equipment, the utility shall notify customer or his agent and shall take whatever actions are necessary to eliminate the hazard, obstruction or violation at the customer's expense.

GROUNDS FOR REFUSAL OF SERVICE

A Utility may refuse to establish service if any of the following conditions exist:

1. The applicant has an outstanding amount due for the same class of utility service and the applicant is unwilling to make arrangements with the utility for payment.

2. A condition exists which, in the utility's judgment, is unsafe or hazardous to the applicant, the general population, or the utility's personnel or facilities.

3. Refusal by applicant to provide the utility with a deposit.

4. Customer is known to be in violation of the utility's tariffs filed with the Commission or of the Commission's rules and regulations.

5. Failure of the customer to furnish such funds, service, equipment, and/or rights-of-way necessary to serve the customer and which have been specified by the utility as a condition for providing service.

6. Applicant falsifies his or her identify for the purpose of obtaining service.

I have read and understand the rules and regulations above.
Applicant Signature *

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Date *

Month Day Year
Date
Co Applicant Signature

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Date

Month Day Year
Date

TAMPERING WITH UTILITY PROPERTY IS PROHIBITED
Without prior approval from the owner, manager, administrator or field technician of Chino Meadows II Water Company, tampering in an form, with or without damage to the property of the water company, is prohibited and COULD RESULT IN CRIMINAL CHARGES AND/OR FEES.

Any person or persons who have been authorized by the aforementioned company representative to access the meter box, turn on or turn off the water supply, read the meter or otherwise manipulate the property of the company in any way shall be responsible for the care, function and safety precautions of the property. If damage results to any components of the company’s property, or interruption of service due to neglect (intentional or unintentional), or failure to return the components to their original state, you as the applicant may be held liable for physical damage to and/or replacement of those components and the labor expenses to repair such damage.
Applicant Signature *

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Date *

Month Day Year
Date
Co Applicant Signature

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Date

Month Day Year
Date
Should be Empty:

Application for Water Service

APPLICANT

Co-Applicant