Meter Installation Request

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Name *

Builder requesting new service.

Mailing Address Line 1 *

Mailing Address Line 2

City *

State

Zip Code *

Representative Name *

First

Last

Person in charge of the project on behalf of the builder.

Position Title *

Phone *

Alternate Phone

Email *

Service Address *

Subdivision Name *

Block # *

Lot # *

Tax Parcel # *

Township *

Range *

Section *

Federal Tax ID *

I declare that I am a representative of the aforementioned corporation and that the officers of the corporation have authorized me to enter into this agreement for, and on behalf of, said corporation; and on behalf of the officers of the aforesaid corporation, I further declare that the corporation is in the business of construction in the Green Valley area; and to facilitate our obtaining approval for water service at the above new construction sites, and to comply with the Arizona Corporation Commission Codes, we do hereby agree to abide by and comply with all terms and conditions as approved by the Arizona Corporation Commission, relating to the Application for Water Service as requested herein, and further agree that we will be responsible for payment of same at the approved rates; and we further agree to maintain the plumbing at the above new construction site in compliance with the current edition of the Uniform Plumbing Code for Water System Safety. *

I agree