TEST FORM

New water service-(for new or returning Springdale Water customers)

Transferring water service-(for current Springdale Water customers that are transferring water service to a new location serviced by Springdale Water)

Please select which service you are applying for: *

New Water Service
Transferring Water Service

Click Here to view required deposit schedule, fees, and rates.

Please include address and/or account number you are transferring water service from: *

Have you had service with Springdale Water before? *

Yes
No

If yes, please enter account number and/or service address:

What type of property is it? *

Commercial
Residential

Property Ownership: *

Rent
Own

Landlord Name: *

Landlord Phone Number: *

Upload copy of rental lease: (We require all tenants moving into a rental property to provide a copy of their lease to open an account) *

Acceptable file types: .bmp, .gif, .jpeg, .jpg, .doc, .docx, .odt, .pdf, .png, .tif, .tiff

Disconnection Date (old account): *

Requested Start Date: *

Service Address: *

Mailing address different? *

Yes
No

If yes, please list mailing address:

Address Line 1

City

State / Province / Region

Postal Code

Account Holder Name: *

First

Last

Phone Number: *

Drivers License Number: *

State: *

Upload Color Copy of DL: *

A front sided color copy of current government issued photo ID is required to set up service | Acceptable file types: .bmp, .gif, .jpeg, .jpg, .doc, .docx, .odt, .pdf, .png, .tif, .tiff

Additional Authorized Resident or Spouse:

First

Last

Additional Contact Number:

Additional Contact Drivers License:

Additional Contact State:

Additional Contact Drivers License File Upload:

Acceptable file types: .bmp, .gif, .jpeg, .jpg, .doc, .docx, .odt, .pdf, .png, .tif, .tiff

Email *

Company/Organization Name: *

Company Number: *

Company Contact Name: *

Secondary Number:

Are you tax exempt? (ie non-profit) *

Yes
No

Upload tax exemption paperwork: (required if you are requesting to be tax exempt) *

Acceptable file types: .bmp, .gif, .jpeg, .jpg, .doc, .docx, .odt, .pdf, .png, .tif, .tiff

Tax ID or Drivers License are required for Commercial Accounts. Please fill one out.

Tax ID:

Drivers License Number:

State:

DL Copy Upload: (Color copy of current government issued photo ID is required to set up service if registering with DL# instead of Tax ID):

Acceptable file types: .bmp, .gif, .jpeg, .jpg, .doc, .docx, .odt, .pdf, .png, .tif, .tiff

Are you the landlord and plan on renting this property to others? *

Yes
No

Is the property currently vacant? *

Yes
No

Would you like to suspend trash service at this location? *

Yes, I have read and agree to the Vacant Property Agreement
No, I would like to keep trash service at this location

Date: *

E-Signature: *

Deposit Agreement *

I have read and agree to the Deposit Agreement *

Please read these Deposit Agreement terms and conditions.

A deposit is being tendered by the applicant, who agrees: (i) to furnish at his/her expense a suitable
meter box and to use diligence to protect the same from frost and accident; (ii) to comply with all rules
and regulations adopted by the Springdale Water and Sewer Commission d/b/a Springdale Water
Utilities and the ordinances of the City of Springdale; (iii) that Springdale Water Utilities may terminate
service for failure to pay amounts due to Springdale Water Utilities, whether it is for water, sewer, or
any amount Springdale Water Utilities may be collecting for other services pursuant to contract,
including solid waste or garbage pickup; and, (iv) that this deposit may be applied to any outstanding
amounts owed by applicant to Springdale Water Utilities for water and sewer service provided to
applicant. For meters being used for construction use, the undersigned is fully aware that all
construction on premises covered by this application shall conform to all ordinances, building codes,
rules and regulations adopted by the City of Springdale or Springdale Water Utilities, governing
construction of buildings and structures within the limits of Springdale or its planning jurisdiction.
Springdale Water Utilities shall refund in full a deposit for meters used for construction upon request of
depositor or his authorized representative when the following conditions have been met: 1) compliance
with all City of Springdale regulations, and presentation to the department’s cashier evidence of the City
Building Inspector’s approval of construction; 2) presentation of depositor’s copy of this application; 3)
discontinuance of the temporary water service; and 4) payment of the account in full. Deposit shall be
retained in escrow without interest by Springdale Water Utilities. Springdale Water Utilities shall apply
deposit to any outstanding balance and will return balance of deposit herewith, when service is
discontinued and all rules and regulations have been fully complied with.

Service you can trust.

TEST FORM

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