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2. DAVE LOWERY

   ^MAYOR

   CHRIS LIGHTFOOT

   ^{INTERIM CITY MANAGER} 

   AMY MYERS

   ^{CITY ATTORNEY}

3. 

4. COMMISSIONERS 

   SAM PEEBLES 

   PAT PERNO 

   JAMIE WARRICK 

   JUDY TINDER

6. REQUEST TO STOP SERVICES

   Request must be received by 3PM for same day service. A final bill will be generated once final reading is obtained.

8. Account Owner's Name*
9. Date to Turn Off*
   Date to Turn Off

   Business hours only

11. Secondary Owner's Name (if applicable)
13. Service Address (Please include APT # if applicable)*
15. City*
16. State*
17. Zip Code*
19. New Mailing Address (Please include APT # if applicable)*
21. City*
22. State*
23. Zip Code*
25. Phone Number*
26. E-Mail Address*
28. Turn off the Irrigation meter if applicable?*

    1. Yes

    1. No
30. Drivers License (Primary owner)*
31. Drivers License (Secondary Owner)
33. Comments:
35. Agreement

    I HAVE READ AND UNDERSTAND THAT BY SIGNING BELOW, I AGREE TO THE FOLLOWING:

    
    

    If an incorrect address is given above, there will be an additional water connection fee for each corrected meter. 

    A final reading will be obtained on the date requested above which will result in a final bill. Deposits, if on file, will be applied to any outstanding balances. 

37. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
39. Electronic Signature*
40. Date:*
    Date:
42. Secondary Electronic Signature
43. Date:
    Date:
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field