Application for Utility Service

Application for Utility Service

(Please Complete One Request Per Location)
Name of District
Date

MonthDayYear
Date
Service Address

Street Address

Street Address Line 2

CityState

Zip Code
Name

First NameLast Name
Company Name (If Applicable)
Business Tax Id (If Applicable)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Water Service Effective Date

MonthDayYear
Date
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code
Do You Rent or Own Property (Residential & Commercial)
File Upload For Faster Processing

Cancelof
Is Irrigation / Sprinkler System Installed?
Pool / Spa?

Previous Address (Residential Only / Recommended For Faster Processing)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Company Name
Employer Phone
Employer Address

- Applicant is required to sign a Customer Service Agreement in order to receive service.
- Applicant have to provide a copy of Photo ID upon request for identification purposes
- Applicant’s failure to adhere to all requirements contained in the District’s Rate Order may result in fines, penalties and a delay or denial of service establishment. A copy of the District’s Rate Order is available upon request.
Drivers License Number
Must provide copy of photo ID/License
Drivers License State
Birth Date

MonthDayYear
Date
Signature
Should be Empty: