HCFWSD #61 Application for Water & Sewer Services

Please complete all required* information below to apply for water service.

Deposit and Service Fees

• $200 Deposit: Required per residential unit for renters, realtors, property managers, and non-owner occupants.
• $125 Deposit: Required per residential unit for owner-occupied residences. Proof of ownership must be provided within 5 business days.
• $25 Move-In Service Charge: This fee will appear on the customer’s first month’s water bill.
• $50 Reconnection Fee: Applies when water service is terminated due to non-payment or failure to return the completed application for service within the allotted time frame.
• $50 Tampering Fee: Applies when a company-owned water meter is illegally turned on or off.

The undersigned subscriber does hereby make application for water and sewer service at the following address:

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Name *

First

Last

Service Address *

Mailing Address *

City, State, Zip *

Email *

Phone Number *

Zip Landlord's Co-Applicant

Driver's License # *

Social Security # *

Co-Applicant

First

Last

Co-Applicant Email

Co-Applicant Phone #

Co-Applicant Driver's License #

Co-Applicant Social Security #

Paperless Billing Email

Application Status, Check One: *

• Owner
• Renter
• Property Manager

Landlord's Name

Landlord's Phone Number

Landlord's Address

Preferred Start Service Date *

Signature *

Submit

All rates, deposits, etc., shall be in accordance with the most current Rate Order of the District and are subject to change.

Upon WRITTEN NOTICE from the subscriber to the District to discontinue its serviec provided said premises, said deposit, or its remainder, shall be refunded to this applicant. The District reserves the right to apply the deposit against unpaid charges.