New Water Service Application

Name*

First NameLast Name

Address of New Service*

Street Address

Street Address Line 2

CityArkansas

Postal / Zip Code

Email

example@example.com

Phone Number*

Please enter a valid phone number.

What address did you most recently have water utility service connected to? (Previous address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Arkansas Drivers License or Arkansas ID Card Number*

Social Security Number

Date of Birth*

Date

Is this a rental property? *

If this is a rental property, additional information is required from the landlord/property manager/property owner before service can be established.

Date you wish to have water service connected

Date

Property Owner/Landlord Name

First NameLast Name

Please download the Landlord Rental Agreement and attach to your application.

Please Upload the completed Landlord Rental Agreement here.

Property Owner/Landlord Phone Number

Please enter a valid phone number.

Property Owner/Landlord Email

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Phone

Please enter a valid phone number for the person we may contact if there is an emergency where the Water Department needs to interrupt service due to a water leak or issues and you are unavailable.

Casa Water Facility Water Department Policy and Procedure:

Water Bills:
Bills are mailed on the first of the month, if you have not received your statement by the 5th day of the month, please call the water department at the number listed above. If there is an error or you have questions, please give us a call.

Bills are due by the 15th day of the month. If the 15th falls on a Thursday or Friday, customers will have until the next business day before a late fee is implemented. If your bill is not paid by the last day of the month your water service will be disconnected.

Re-Connection Fee: $100.00
If you want your water re-connected after hours or on weekends, an additional $50.00 service call fee will be added to your bill.
Damage to Water Department Lock: $150.00

New Water Customers:

Homeowners (Copy of the Deed as proof of ownership is required)
Connection Fee: $20.00
Meter Deposit: $50.00

Renters:
Connection Fee: $20.00
Meter Deposit: $155.00

New Installs:
Connection Fee: $20.00
Meter Deposit: 50.00
Parts/Labor: $700.00 *
*Additional charges may apply if the water line has to cross the roadway.

Reconnect Fee:
$100.00

Signature: I agree to abide by the policies and procedures set forth by the Casa Water Facility. My signature below indicates that I have read and agree to these policies. *