Office Use Only:
Acct#: 		 Date of Acct Svc:			 ID verified and DL # 	
New Utility Service Reinstate/Update Account
Staff Initials 	

Applicants are required to provide the following documentation with application to establish a New Account or Reinstate/Update Utility Services:
•	Completed Acknowledgement and Release of Liability form (aka: Waiver)
•	Personal ID such as a driver’s license of applicant or legal
representative
•	Copy of legal proof of ownership or other interest to the property

Complete the following information (PLEASE PRINT)
Check one:	 Owner	 Tenant	 Property Manager	 If other, please indicate: 	
Utility Service Address (Property Address)

Applicant’s Name: Only print one name as shown on individual’s identification. For Business: print business name as shown on legal documentation. This is the primary account holder (Owner of property or legal representative responsible for the service location.)

(The security deposit placed on this account will be credited only to the above applicant and is non-transferable)

Mailing Address

City		State		Zip-Code		

Main Telephone # (Required)		E-Mail Address		

Receive E-Bills	¨ Yes ¨ No	SLWSD will send communications by phone and email	

Alternate Contact Name (if applicable)

Alternate Contact Phone # (if applicable)

Business	(DBA)	(TAX ID #)
What type of commercial use?	(Businesses may be subject to additional connection fees)

Electronic Application and electronic signature: If this Application is submitted electronically, Applicant (i) agrees that such action constitutes an electronic signature on the Application, and (ii) affirms and acknowledges that all information in the Application and supporting documentation is true and correct.

The applicant shall be responsible for rendering all required deposits and other fees and charges in accordance with the Rules of the SLWSD prior to the SLWSD rendering service. Every new account requires a deposit based on the meter size for the service location. The deposit is neither negotiable nor transferable. Statements are monthly and payments are due by the due date every month regardless of whether the service is being used. Past due bills are subject to a 10% penalty and/or discontinuation of service. Failure to receive a bill does not waive the penalty. The owner of the property at the service location is responsible for all outstanding account balances. The SLWSD may withhold service to a consumer who makes application for service at or upon a location for which prior service has not been paid in full to the date of such application. Should any account balance become past due after the final settlement of that account, the outstanding account balance shall be applied to the next consumer’s account for that service location and may result in service being terminated if not paid within twenty (20) calendar days of the date of the SLWSD written notice of the outstanding account balance. If this date falls on a weekend or SLWSD holiday, then the due date shall be the next business day.
All properties serviced by SLWSD are required to pay a minimum monthly base rate in addition to usage charges. The SLWSD’s rate schedules impose monthly water and wastewater base facility charges upon each service connection so that every month, the SLWSD bills its consumers for base facility charges plus charges for actual consumption. Therefore, even if a consumer has no measurable metered water usage during a given month, the SLWSD nonetheless bills the consumer for the monthly base facility charges. Irrigation service charges are also billed monthly on a fixed rate; however, because irrigation service is not metered, the consumer is not charged extra for usage. Base facility charges for water and wastewater may be found in Schedule A to the Rules of the SLWSD, and fixed charges for irrigation service may be found in Schedule D.
By signing the application, I understand and agree to abide by the Rules of the SLWSD. I also understand that this application will not be processed if the application is incomplete. Applications will be deemed incomplete if the applicant fails to submit any required information, documentation, deposits, and other applicable charges. One business days’ notice is required to process this application.
Applicant Signature: 	 Date: 	
Print Name of Signee: