Bulk Water Agreement

Bulk Water Agreement
Company Name*
Owner*

First NameLast Name
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Upload a copy of drivers license/valid state ID*

Cancelof
I agree to pay for bulk water received from the City of Mineola. I have been informed of the regulations of the City of Mineola for Bulk water usage. I am aware that if these regulations are not followed, my privileges will be revoked.
Signature
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