Fire Hydrant Meter Application

Spanish Fork City

Fire Hydrant Meter Application

Billing Information

The base rate will be billed monthly. However, since these meters have to be read manually, usage will only be billed quarterly.
These meters are billed at the same base rate and usage rate as a 2 inch pressurized irrigation meter. Click here to see our current rates.
You will receive a utility bill each month that is due on the 25th of the following month.
When the account is terminated the deposit will be applied to the balance on the account and the remainder will be refunded to you.

Are you applying as a Business or Individual?*

BusinessIndividual

Is this project funded by Spanish Fork City?*

YesNo

What is the City project you are working on?*

Reason for Use & Expected Amount of Use*

Legal Name of Business*

Name of Contact Person*

First NameLast Name

Business EIN #

Name*

First NameLast Name

Social Security #*

Birth Date*

Identification Type*

Identification Expiration Date*

State ID Number*

State Issuing ID*

Drivers License Number*

State Issuing Drivers License*

Passport Number*

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Used to contact you to train on handling *

Area CodePhone Number

E-mail*

example@example.com

Applicant Signature Agreeing to Utilities Contract*

Fire Hydrant Use Requirements

1. Operators of hydrant must be listed on the permit as trained. Meter assembly will be issued at training.
2. Water may not be used outside City boundaries unless on City projects or as authorized by the City Engineer.
3. This permit shall remain at the hydrant location or with the authorized permit holder at all times the hydrant is being used.
4. Use only approved devices and equipment supplied by Spanish Fork City on hydrants.
5. Hydrant MUST be COMPLETELY turned on or off at all times. Flow shall be controlled by approved gate valve on meter assembly.
6. Permittee is responsible to ensure that air-gap backflow prevention occurs at all times of hydrant use.
7. Permitee is responsible for any damage to the hydrant or meter assembly equipment incurred during time of permit period.
8. Meter assembly shall be removed when not in use for longer than 8 hours.
9. Spanish Fork City and Spanish Fork Fire Department require unobstructed access to the hydrant and meter assembly at all times.
10. Permittee shall pay for all water use according to current Spanish Fork City Rates.
11. A violation of this permit shall be a Class C Misdemeanor.

Would you like to enroll in ACH Auto Pay*

ACH Auto Pay automatically pulls the payment from your bank account on the due date of each month.

Authorization Agreement

I hereby authorize Spanish Fork City Corp. to initiate automatic withdrawals from my account at the financial institution named below. I understand that payment will be deducted from my account on the due date of each month or the following business day if the due date is on a weekend or holiday.

I understand that I am responsible to pay a returned item fee of $20 as specified by the City for any automatic debit that is returned to Spanish Fork City for any reason. In addition, I understand that I will be removed from automatic withdrawals and that a $200 deposit will be required.

Further, I agree not to hold Spanish Fork City Corp. responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in withdrawing funds from my account.

This agreement will remain in effect until Spanish Fork City Corp. receives a written notice of cancellation from me or my financial institution, or until I submit a new/updated ACH Auto Pay form to Spanish Fork City.

I understand that if I make a payment using another payment method (i.e. in office with cash or check or online with a card) after the 15th of the month, my automatic payment may still be deducted on the due date by Spanish Fork City and I assume responsibility for any bank/credit union fees that may result.

Financial Institution*

Type of Account*

CheckingSavings

Routing Number*

This is always 9 digits

Account Number*

Routing Number: first 9 digits

Account Number: digits in between the routing number and the check number

Signature - Authorization to Sign Up for ACH Auto Pay*

Calculation

Amount Due*

USD$1,500 Deposit and $100 Setup Fee. Application will not be submitted if the card is declined.

Credit Card

Water Department Use

Meter Reading _____________________ Meter ID # ____________________________

Hydrant is working properly ________________ YES/NO _____

Operator Name _________________________________ Trainer Initials ______

Business Information

Applicant Information

Customer Authorization for ACH Auto Pay

Credit Card