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P.O. Box 100 • Vail, AZ 85641 • (520) 647-3679
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Hydrant Meter Service Agreement
Request Information
Requested Start Date:
Construction
Yes
Service Address
Address
City
State
Zip
Applicant Info:
Business Name:
Contact:
Email:
Current Phone:
Mailing Address:
Address
City
State
Zip
Backflow Needed
(Please Check Box)
Yes
No
I/WE HEREBY APPLY FOR SERVICE AT THE ABOVE REFERENCED SERVICE ADDRESS AND AGREE TO ABIDE BY ALL THE RULES AND REGULATIONS SETFORTH BY VAIL WATER COMPANY AS DETERMINED BY THE ARIZONA CORPORATION COMMISSION. I/WE UNDERSTAND THE INITIAL CHARGES LISTED BELOW MAY BE SUBJECT TO CHANGE.
1.
Establishment Fee
$25.00
Establishment Fee
(Non-Refundable)
2.
Deposit
(First time customer)
$500.00
(subject to change)
Deposit
(Applied to Final Bill)
BY SIGNING THIS AGREEMENT I/WE ACCEPT FULL RESPONSIBILITY AND RELEASE VAIL WATER ANY LIABILITY FOR DAMAGES DUE TO OPEN OR DEFECTIVE WATER SYSTEM ON CUSTOMER SIDE OF METER.
Applicant Signature
Date
Use this option to automatically email your address change to us. Our staff will receive it, check it and send you a confirmation.
If you prefer to print and sign your request:
You will then need to return this signed form to Vail Water Company in one of the following ways:
Fax: (520) 647-3825
E-mail: customerservice@vailwater.com
Mail: Vail Water Company
P.O. Box 100
Vail, AZ 85641
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