New Service - Plant Standpipe
This form is to establish service at our Plant Standpipe in Buckeye, AZ
Business Name
Business Name
Tax ID Number
Tax ID Number
Email
example@example.com
Name
*
First Name
Last Name
Title
Title
Driver's License or State Issued ID Number
*
Please include the issuing state
A copy of your Driver's License or State Issued ID is required
*
Browse Files
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Primary Phone Number
*
Please enter a valid phone number.
Primary Phone Type
*
Please Select
Home
Cell
Work
Secondary Phone Number
Please enter a valid phone number.
Secondary Phone Type
Please Select
Home
Cell
Work
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When would you like to begin Drawing Water?
*
-
Month
-
Day
Year
Date
Additional Comments or Information
Additional Comments or Information
Signature
*
By signing you agree to the Terms & Conditions as well as the Rules & Regulations set forth by the Arizona Corporation Commission
Please verify that you are human
*
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