Name:
Contact Email:
Account:
Parcel No:
Deposit: $
Service Address:
Mailing Address:
Applicant’s Phone No.:
Applicant’s Driver’s License No.:
Owner's Name:
Owner's Phone No.:
Owner's Mailing Address:
Identification and ownership will be verified through independent sources. By signing this application, the applicants agree to observe any current or future district regulations.

By Submitting this form I have read and understand the information on the bottom of this application.

Temporary Service – A tenant may be given temporary service for fifteen (15) days upon payment of a security deposit and by furnishing the district with a copy of the valid rental agreement, the owner’s name, mailing address and telephone number. The security deposit will be held on the tenant’s account upon receipt of the signed application for service from the owner. In order to establish credit history with the District, the security deposit will be held on the account for a minimum of twelve months.

The owner’s application must be received by the district within ten (15) days or service will be disconnected.
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