Choose One: New Owner New Tenant

Water Service Address:

Service Date:

Billing Name:

Billing Address:

Billing City State Zip:

Phone Number:

Cell Phone Number:

Email Address:

Name of Property Owner:

Property Owner Address:

Property Owner Phone:

As an applicant for service I acknowledge and accept the following responsibilities:

• There is a $50.00 water deposit that will be paid at the time the account is set up. We accept check, cash, money orders and credit card payments.
• The meter and turnoff valve are the property of the city and tampering with either item is prohibited by law.
• All pipes, valves and connections from the owners side of the meter to the business or dwelling is the sole responsibility of the property owner.
• All water bills are due the 15th of every other month. A late charge is applied to accounts paid after the 15th.
• If it is necessary for a city employee to shut off water at the business or dwelling the following charge applies: SHUT OFF $25.00.
• There is a charge of $20.00 for returned checks.

I have read these rules and understand they will be strictly enforced by the city as a condition of continued water service.

Authorized Signature:

Today's Date: