APPLICATION FOR COMMERCIAL WATER SERVICE

APPLICATION FOR COMMERCIAL WATER SERVICE
Company Name
Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer I.D. Number or Social Security Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Today's date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Date service requested to begin

MonthDayYear
2 digit month, 2 digit day, 4 digit year
For same day service, applications must be received according to the following schedule:
Time 8 a.m.-11 a.m. must be received before 8:30 am Monday – Friday.
Time 12:30 p.m. - 3 p.m. must be received before noon Monday – Friday.
Time Selection
Type a question
The undersigned hereby requests Water Works District No. 3 of Rapides Parish to render water service at the above service address, grants to the District the necessary right-of-way for the extension of such service which is binding upon the undersigned's heirs or assign, and agrees to receive from and pay the District all such services required on the premises at above service address, in accordance with applicable rates and with the service regulations of the Water District.

The Water Works District No. 3 of Rapides Parish has "Intergovernmental and Cooperative Endeavor Agreements" in effect with the City of Pineville, Town of Ball, and Rapides Parish Sewerage District No. 2, that allow termination of your water service for failure to pay your public utility/services bill from those agencies. Those public utility/services bills must be paid directly to those agencies and Water Works District No. 3 of Rapides Parish cannot accept any payment for those utility/services bills.
Please provide a copy of your drivers license and/or photo ID:

If you are unable to provide a photo ID at this time, please fax it to 318-641-9223 at your earliest convenience.
Cancelof
Signature
Title
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Please verify that you are human
Should be Empty: