Vail Water.

Start Service Application

Service request must be submitted before 2:30 p.m. Monday-Friday for next business day service, excluding major holidays.

Requested Start Date:

Are you (select one):

Owner Tenant

Service Address

Address

City

State

Zip

Applicant Info

Name

Date of Birth

Phone

Co-Applicant Info

(co-applicant has all privileges including open/close, billing inquiry, or payment)

Name

Date of Birth

Phone

Mailing Address

(if different from service address)

Address

City

State

Zip

Landlord/Property Mgr Information

(if applicant is tenant)

Landlord Name

Landlord Phone

AGREEMENT

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.	Guarantee Deposit	$75.00	Guarantee Deposit (Applied to Final Bill) (subject to change)
3.	Same Day Fee	$50.00	Same Day Service Fee (If applicable) (Non-Refundable)

TOTAL AMT (will be on 1st bill)		$100.00	Charges applied to 1st Bill

For Same Day Service

I understand that an addiitional $50.00 fee will apply.
(initial here)

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.

BY CLICKING AGREE BELOW AND TYPING MY NAME IN THE SIGNATURE BOX I AM SIGNING THIS AGREEMENT AND THAT ALL INFORMATION IN THIS FORM IS ACCURATE TO THE BEST OF MY KNOWLEDGE.

I Agree

Applicant Signature * Date *
Co-Applicant Signature Date

Use this option to automatically email your application 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