Commercial Customer Application

Service Address

Effective Date

Company Name

Taxpayer Identification Number

Contact Name

Phone Number

Business Email Address

Is your mailing address the same as your service address?

If No, What is the mailing address?

City, State, Zip

Previous Service Address

Previous Service Address City, State, Zip

Would like to signup for Preauthorized Payments ?

If Yes, Enter Routing Number

If Yes, Enter Account Number

Disclaimer As owner of the real property listed above, I understand I am responsible for any unpaid debts that may accrue through the use of the District water consumed on the property. As the property owner, I acknowledge and agree that a lien may be placed on the property should these debts remain unpaid. I am aware that if a delinquency occurs on one account, all accounts held are subject to disconnection. I am aware that at the appropriate time, it is my responsibility to contact the District to close my account.

Applicant Name

Applicant Phone Number

Applicant Signature

Date Signed

Lease Agreement, Grant Deed, or Closing Disclosure