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.
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)*

Rent (Please provide a copy of your lease)Own (Please provide ownership statement)
File Upload For Faster Processing

Cancelof
Is Irrigation / Sprinkler System Installed?

YesNo
Pool / Spa?

YesNo

- 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*

Clear
Should be Empty: