Application for Water Service and Deposit Receipt

Please fill out the appropriate form below in gray and hit SUBMIT at the bottom.

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Fees, Charges & Forms

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Landlord Agreement (PDF)

APPLICATION FOR WATER SERVICE and DEPOSIT RECEIPT

WHO YOU ARE:*
- OWNER
- RENTER / TENANT
- PROPERTY MANAGER
SERVICE START DATE:*
MM
DD
YYYY
SERVICE ADDRESS:*
Street Address Address Line 2 City State ZIP Code
APPLICANT NAME:*
First Last
APPLICANT PHONE NUMBER:*
APPLICANT EMAIL ADDRESS:
APPLICANT SOCIAL SECURITY NUMBER:
BILLING ADDRESS SAME AS SERVICE ADDRESS?*
- Yes
- No
BILLING ADDRESS:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
EMPLOYER NAME:*
EMPLOYER ADDRESS:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
EMERGENCY CONTACT NAME:*
First Last
EMERGENCY CONTACT PHONE:*
EMERGENCY CONTACT ADDRESS:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
The undersigned, referred to as the Applicant, hereby agrees to pay all costs of fees and/or properties due under this AGREEMENT including, but not limited to, attorney’s fees and court costs set by the court, sitting without a jury. If Applicant changes service address or adds an additional service address, they will be bound by this application. The Applicant further agrees to be governed by the Ordinances/Regulations pertaining to water. The Applicant also agrees to the following:
1. A deposit in the amount of (see below). This deposit may be applied to Applicant’s account, upon request, after twelve months of acceptable credit and shall be defined as not more than two late charges within a one (1) year period.
  - 5/8 x 3/4 inch meter: $200.00 Deposit *Due on or before turn on date
  - 1 to 2 inch meters: Three times base service fee Deposit *Contact the Customer Relations Manager or go on-line to check for Deposit Service Charges
2. A non-refundable service establishment amount of $35.00 will be charged to the Applicant’s first billing cycle. An establishment charge is required for the District’s technical and administrative services in providing the initial service to the to the Applicant.
3. All metered properties shall be billed current monthly base fees under all conditions. A base fee is defined as a monthly fee for each meter connected to the District’s water system whether or not any domestic water is used, and is determined by meter size. This fee does not include costs associated with the water usage or consumption at the property for the period covered, but rather for the costs of the system, which provide the service to the property.
4. The Applicant agrees to pay for services and shall be billed on a monthly basis in accordance with authorized rate/fee schedules. Payments may be made by personal check, cashier’s check, money order, or on-line bill pay by going to the District’s website noted on this form. Transaction fees apply for on-line payments. All rates, fees, and charges are subject to applicable sales tax.
5. The Applicant agrees to use water services for known purposes and agrees not to sell or donate any part of water services for any other purposes.
6. The Applicant agrees that duly authorized agents and employees of the DIAMOND VALLEY WATER DISTRICT shall have uncluttered ingress and egress to the premises for the purposes of operating and maintaining the water system in accordance to safe public utility practices. It shall be the Applicant’s responsibility, at all times, to keep the meter and/or easement (right-of-way) unobstructed and accessible (including, but not limited to, vehicles, vegetation or brush, fencing, and debris). After 30 days of notice, if the violation remains in effect, the District shall take whatever actions are necessary to eliminate the hazard, obstruction, or violation at the customer’s expense.
7. Bills shall be mailed on the first of each month and due by the 20th. The account is considered past due if not paid by the 20th and a late fee of $35.00 will be added to the outstanding balance. Services may be discontinued by the District when account becomes delinquent or 60 days past due. The Applicant agrees to give DIAMOND VALLEY WATER DISTRICT at least five (5) business days’ notice prior to when the Applicant ceases to occupy said premises and when the Applicant desires services to be discontinued. An accurate forwarding address must be provided to the District for the purposes of final billing charges or refundable amount. Applicant shall be responsible for all charges until District is notified to terminate service. In the event of failure on the Applicant’s part to comply with the terms and conditions of this agreement, the Applicant agrees that said DIAMOND VALLEY WATER DISTRICT or its representative may discontinue service here under without notice to the Applicant, and that such discontinuance will not constitute waiver of any claims against the property. Applications and rate schedule are available on-line or upon request.
In consideration for the provision of Water Service the customer agrees to pay the following charges:
5/8 x 3/4 inch meter: $200.00 Deposit*
1 to 2 inch meters: Three times base service fee Deposit Contact the Customer Relations Manager or go on-line to check for Deposit Service Charges
*Due on or before turn on date
A Non-Refundable Service Establishment Charge of $35 shall be applied to the Applicant’s first billing cycle.
SIGNATURE - PLEASE TYPE YOUR FULL NAME:
BY TYPING YOUR NAME HERE YOU AGREE TO THE TERMS OF THIS APPLICATION
Please mail your check to:
DIAMOND VALLEY WATER DISTRICT
P.O. BOX 26527, PRESCOTT VALLEY, AZ 86312-6527

Or call the office to set up an online payment 928-458-5059

APPLICATION FOR NEW CONSTRUCTION HOOK-UP WATER SERVICE

WHO YOU ARE:
- OWNER
SERVICE START DATE:
MM
DD
YYYY
SERVICE ADDRESS:*
Street Address Address Line 2 City State ZIP Code
APPLICANT NAME:*
First Last
APPLICANT PHONE NUMBER:*
APPLICANT EMAIL ADDRESS:*
APPLICANT SOCIAL SECURITY NUMBER:*
BILLING ADDRESS SAME AS SERVICE ADDRESS?*
- YES
- NO
BILLING ADDRESS:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
EMPLOYER NAME:*
EMPLOYER PHONE:*
EMPLOYER ADDRESS:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
The undersigned, referred to as the Applicant, hereby agrees to pay all costs of fees and/or properties due under this AGREEMENT including, but not limited to, attorney’s fees and court costs set by the court, sitting without a jury. If Applicant changes service address or adds an additional service address, they will be bound by this application. The Applicant further agrees to be governed by the Ordinances/Regulations pertaining to water. The Applicant also agrees to the following:
1. A deposit in the amount of (see below). This deposit may be applied to Applicant’s account, upon request, after twelve months of acceptable credit and shall be defined as not more than two late charges within a one (1) year period.
  - 5/8 x 3/4 inch meter: $200.00 Deposit *Due on or before turn on date
  - 1 to 2 inch meters: Three times base service fee Deposit *Contact the Customer Relations Manager or go on-line to check for Deposit Service Charges
2. All metered properties shall be billed current monthly base fees under all conditions. A base fee is defined as a monthly fee for each meter connected to the District’s water system, unless the meter is locked off, and is determined by meter size. This fee does not include costs associated with the water usage or consumption at the property for the period covered, but rather for the costs of the system, which provide the service to the property.
3. The Applicant agrees to pay for services and shall be billed on a monthly basis in accordance with authorized rate/fee schedules. Payments may be made by personal check, cashier’s check, money order, or on-line bill pay by going to the District’s website noted on this form. Transaction fees apply for on-line payments. All rates, fees, and charges are subject to applicable sales tax.
4. The Applicant agrees to use water services for known purposes and agrees not to sell or donate any part of water services for any other purposes.
5. The Applicant agrees that duly authorized agents and employees of the DIAMOND VALLEY WATER DISTRICT shall have uncluttered ingress and egress to the premises for the purposes of operating and maintaining the water system in accordance to safe public utility practices. It shall be the Applicant’s responsibility, at all times, to keep the meter and/or easement (right-of-way) unobstructed and accessible (including, but not limited to, vehicles, vegetation or brush, fencing, and debris). After 30 days of notice, if the violation remains in effect, the District shall take whatever actions are necessary to eliminate the hazard, obstruction, or violation at the customer’s expense.
6. Bills shall be mailed on the first of each month and due by the 20th. The account is considered past due if not paid by the 20th and a late fee of $35.00 per month will be added to the outstanding balance. Services may be discontinued by the District when account becomes delinquent or 60 days past due. The Applicant agrees to give DIAMOND VALLEY WATER DISTRICT at least five (5) business days’ notice prior to when the Applicant ceases to occupy said premises and when the Applicant desires services to be discontinued. An accurate forwarding address must be provided to the District for the purposes of final billing charges or refundable amount. Applicant shall be responsible for all charges until District is notified to terminate service. In the event of failure on the Applicant’s part to comply with the terms and conditions of this agreement, the Applicant agrees that said DIAMOND VALLEY WATER DISTRICT or its representative may discontinue service here under without notice to the Applicant, and that such discontinuance will not constitute waiver of any claims against the property. Applications and rate schedule are available on-line or upon request.
In consideration for the provision of Water Service the customer agrees to pay the following charges:
```
DVWD HOOKUP FEE               $4,500.00  
DEPO                          $200.00*
ESTABLISHMENT FEE             $35.00
 
TOTAL DUE                     $4,735.00
```
*** Plus all DVWD costs of service installation by a DVWD approved contractor. This cost may vary depending on construction conditions and the cost is the builder's responsibility.
*Due on or before turn on date
SIGNATURE - PLEASE TYPE YOUR FULL NAME:*
BY TYPING YOUR NAME HERE YOU AGREE TO THE TERMS OF THIS APPLICATION.
Please mail your check to:
DIAMOND VALLEY WATER DISTRICT
P.O. BOX 26527, PRESCOTT VALLEY, AZ 86312-6527

Or call the office to set up an online payment 928-458-5059