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2. Water Service Account Number*
4. First Name*
5. Last Name*
7. Service Address*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone number*
16. Email address*
18. Relationship to the Property*

    Check all that apply.

    1. Owner
    2. Tenant
20. Do you agree to the the following?*

    • I have read and understand the New Customer Orientation Package and will have my irrigation system inspected prior to service start up. 
    • I understand that orientation will be required prior to physical connection to the system. It is further agreed that the City shall have the right to enter the above premises as deemed necessary at any time to inspect the reclaimed water piping, fittings and operation of the irrigation system.

    1. I agree
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field