Location #___________________
Account #___________________
On___________
Service Agreement
Off___________
Please complete this “Service Agreement” and provide us with a copy of your Driver’s License.
A deposit is required from renters and business owners (and may be required from homeowners) unless an Autopay Agreement is filled out. It will be required prior to connecting service. For residential customer the deposit amount is $65. If you are a “commercial” customer, the security deposit will be based on the type of business. For all businesses a Tax ID is required in lieu of a driver’s license.
/__/ Owner /__/ Renter /__/ Agent
Application Date: _______________________Date Service to Begin/End: _____________________
Customer’s Name or Business Name: _________________________________________________
Service Address: __________________________________________________________________
Mailing Address (if different): _________________________________________________________
Home #__________________ Work #_____________________ Cell #______________________
E-mail Address____________________________________________________________________
Name of Employer: ________________________________________________________________
Closest Relative or Contact Person (not living with you)
Name ________________________________Telephone ________________________
There is a $25 “Establishment” fee for all services (included on your first month’s bill).
AGREEMENT: I/We, the undersigned, hereby make application to BIG PARK WATER COMPANY for water service. I agree to pay for such services at the regular published rates and in accordance with the rules and regulations, all as approved by the Arizona Corporation Commission, which are made a part hereof. I agree to use such service for my own purposes and agree not to sell or donate any part of same or permit it to be used for any other purpose. I agree that duly authorized agents and employees of BIG PARK WATER COMPANY shall have access to my premises at all reasonable hours for the purpose of installation or removal of meters and inspection of equipment to carrying out this agreement, and I further agree to hold BIG PARK WATER COMPANY harmless from any claims, real or alleged, for loss or damage to property or persons arising out of the delivery of service beyond the point of metering. I agree to give BIG PARK WATER COMPANY a written notice when I occupy said premises and when I desire to discontinue service. In the event of failure on my part to comply with the terms and conditions of this agreement, I agree that BIG PARK WATER COMPANY or its representative, may discontinue service hereunder without further notice to me, and that such discontinuance will not constitute waiver of any claims against me for prior service rendered hereunder by BIG PARK WATER COMPANY.
_______________________________________________ ______________________
Signature of Applicant Date
/_/ Check here to receive your bill electronically