New Service Request

New Service Application

LOCATION INFORMATION

Service Address (required)

Service Start Date (required)

Owner/Tenant (required)

Owner

Tenant

Upload Lease Agreement or Settlement Agreement for Owner Verification

* FOR TENANTS ONLY *

Property Management Co or Landlord

Phone Number

ACCOUNT INFORMATION

First Name (required)

Last Name (required)

Mailing Street or PO Box (required)

Mailing City (required)

Mailing State (required)

Mailing Zip (required)

Primary Phone (required)

Secondary Phone

Email Address (required)

I understand, acknowledge and agree that; (1) I am and shall continue to be bound by the Districts ordinances, resolutions, rules and regulations applicable to cost, control, maintenance, and operations of such Districts utility services; (2) I am personally liable for the prompt and timely payment of all District utility charges incurred for said services; (3) my failure to promptly and timely pay such charges may result, at the District’s option, in the termination of my utility services (in accordance with the procedures of the Utah Code 17b-1-903 (1)(a)), and/or the pursuit by the District of such other enforcement remedies as the District may have at law and/or in equity to enforce the terms of this agreement and the District’s applicable ordinances, resolutions, rules and regulations; (4) whether or not Judicial enforcement is pursued by the District, I shall pay the costs and reasonable attorneys’ fees incurred by the District in connection with collection and/or other enforcement of my obligations, responsibilities, and liabilities hereunder; and (5) the remedies provided herein are cumulative, and the exercise of any other remedy or remedies deemed necessary thereby for the collection of such delinquent amounts.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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Owner Payment Guarantee

Service Address (required)

Property Owner's Name (required)

Mailing Address (required)

City (required)

State (required)

Zip (required)

Primary Phone Number (required)

Secondary Phone Number

Email Address (required)

Is the above property managed by a property management company? (required)

Yes

If so, please list name and phone number

Do you give Ashley Valley Water permission to discuss account information with the property manager?

Yes

As property owner and landlord of the above listed rental property, I understand that I am responsible for the water utility service. I request the utility bill be sent to the tenant at the service address. I also understand and agree that in the event an unpaid utility balance is left owing after a tenant moves out, I, as the property owner, will be responsible for said unpaid balance. I further understand that when the tenant moves out of the property, any unpaid balance will be transferred to me, as the owner. At that time, it will be my responsibility to pay the balance in full before another tenant can be moved into the property. If said balance becomes delinquent, I as property owner and landlord will be responsible for all interest, court costs, and attorney fees necessary for the collection of said balance.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

There was a problem saving your submission. Please try again later.

Please wait while your submission is being saved...

Thank you, your submission has been received.

Owner Payment Guarantee

Attention Landlords! The Owner Payment Guarantee must be completed before a service location can be put into a tenants name. For questions please call our office.