APPLY FOR WATER SERVICE

Use the form below to apply for water service. First you must select single or multiple applicants. If you are applying for service by yourself, select "Single Applicant". If are applying with a spouse or roommate, choose "Multiple Applicants".

WATER SERVICE APPLICATION

Single Applicant
Multiple Applicants
Business Applicants

To apply for Water Service complete the following application. Please be advised that your application will be processed for the next earliest available date. Same day service requests are based on availability and subject to an additional service fee.

You are required to provide identification for all parties listed on application.
You are required to provide your lease/rental agreement showing all occupants of the property.
There is a $100.00 deposit required for all customers unless you are able to provide a letter of credit from a previous utility provider.
Same day service fee is $96.00; next day or future date service fee is $48.00. Service fee and deposit will appear on first bill. Service requests will be processed based upon availability
Deposit can be waived with letter of credit from utility provider.
Please allow 45-60 days to receive your first utility bill.
A Two-Day Notice Is Required to Disconnect Service. Service requests will be processed based upon availability
E-mail notification will be sent within 24 hours of activation. If you do not receive notification, please contact Customer Service at the number below.

(928) 453-4146

CUSTOMER NAME

LAST NAME

*Required

FIRST NAME

*Required

DATE OF BIRTH

*Required

DRIVERS LICENSE NO.

*Required

PLEASE ATTACH A VALID STATE OR GOVERNMENT PHOTO ID

*Required

SERVICE ADDRESS

*Required

MAILING ADDRESS (STREET NO. & STREET NAME)

*Required

MAILING ADDRESS (CITY)

*Required

MAILING ADDRESS (STATE)

*Required

MAILING ADDRESS (ZIP CODE)

*Required

PRIMARY PHONE

*Required

SECONDARY PHONE

E-MAIL ADDRESS

*Required

*There is a $100.00 deposit required for all customers unless you are able to provide a letter of credit from a previous utility provider.

ATTACH A LETTER OF CREDIT (IF APPLICABLE)

DATE SERVICE TO BEGIN

*Required

Your first bill will be sent to you by mail.
$96 fee applies to same day service requests.
Same day service requests must be made by 12 noon MST and will be processed based upon availability.
All other service requests will be scheduled for the next available business day.
Service requests are completed Monday through Friday 8 am to 5 pm, excluding City holidays.

I have read and agree to the above information.

(This field is required)

PREVIOUS SERVICE LOCATION (LOCAL SERVICE ONLY)

ARE YOU THE PROPERTY OWNER?

Yes
No

IF NOT, LIST LANDLORD/PROPERTY MANAGER

ATTACH COPY OF RENTAL AGREEMENT

EMPLOYER NAME

*Required

EMERGENCY CONTACT

NAME

RELATIONSHIP

PHONE

City Regulations State:

Should utility services be discontinued by the City because of failure of the user to pay any of the charges therefore, services shall not be restored to the premises involved unless and until all charges which are delinquent, including penalties, and/or required deposits, if any, have been paid in full. The City will make a charge for restoring service which has been discontinued by reason of non-payment. Per City Ordinances, as long as there is water service to a residential property, the monthly trash charge and minimum sewer charge is mandatory. A 10% penalty charge is applied if payment is not received within 5 days of the due date on your bill. Further, City regulations provide that utility services include water, sewer, and trash and that the application of any payment will be in order: penalty, tax, trash, sewer, and then water. Non-payment of any portion of the utility bill may result in a delinquent water balance and possible discontinuance of water services. Every applicant shall be liable for services furnished until the city receives written or verbal notice to cancel and shut off services. Deposits are applied to any outstanding balance and/or service charge when the account becomes final. Refunds are issued within 30 days if the deposit exceeds amount owed.

I have read and understand the City regulations governing these utility services and charges.

(Required field)

*If the submit button does not work properly, make sure all required fields have been completed on this application.

You are required to provide identification for all parties listed on application.
You are required to provide your lease/rental agreement showing all occupants of the property.
There is a $100.00 deposit required for all customers unless you are able to provide a letter of credit from a previous utility provider.
Same day service fee is $96.00; next day or future date service fee is $48.00. Service fee and deposit will appear on first bill. Service requests will be processed based upon availability
Deposit can be waived with letter of credit from utility provider.
Please allow 45-60 days to receive your first utility bill.
A Two-Day Notice Is Required to Disconnect Service. Service requests will be processed based upon availability
E-mail notification will be sent within 24 hours of activation. If you do not receive notification, please contact Customer Service at the number below.

(928) 453-4146

CUSTOMER NAME

LAST NAME

*Required

FIRST NAME

*Required

DATE OF BIRTH

*Required

DRIVERS LICENSE NO.

*Required

PLEASE ATTACH A VALID STATE OR GOVERNMENT PHOTO ID

*Required

SPOUSE/ROOMATE

LAST NAME

FIRST NAME

DATE OF BIRTH

*Required

DRIVERS LICENSE NO.

*Required

PLEASE ATTACH A VALID STATE OR GOVERNMENT PHOTO ID

*Required

SERVICE ADDRESS

*Required

MAILING ADDRESS (STREET NO. & STREET NAME)

*Required

MAILING ADDRESS (CITY)

*Required

MAILING ADDRESS (STATE)

*Required

MAILING ADDRESS (ZIP CODE)

*Required

PRIMARY PHONE

*Required

SECONDARY PHONE

E-MAIL ADDRESS

*Required

*There is a $100.00 deposit required for all customers unless you are able to provide a letter of credit from a previous utility provider.

ATTACH A LETTER OF CREDIT (IF APPLICABLE)

DATE SERVICE TO BEGIN

*Required

Your first bill will be sent to you by mail.
$96 fee applies to same day service requests.
Same day service requests must be made by 12 noon MST and will be processed based upon availability.
All other service requests will be scheduled for the next available business day.
Service requests are completed Monday through Friday 8 am to 5 pm, excluding City holidays.

I have read and agree to the above information.

(This field is required)

PREVIOUS SERVICE LOCATION (LOCAL SERVICE ONLY)

ARE YOU THE PROPERTY OWNER?

Yes
No

IF NOT, LIST LANDLORD/PROPERTY MANAGER

ATTACH COPY OF RENTAL AGREEMENT

EMPLOYER NAME

*Required

EMERGENCY CONTACT

NAME

RELATIONSHIP

PHONE

City Regulations State:

I have read and understand the City regulations governing these utility services and charges.

(Required field)

*If the submit button does not work properly, make sure all required fields have been completed on this application.

You are required to provide identification for all parties listed on application.
You are required to provide your lease/rental agreement showing all occupants of the property.
There is a $100.00 deposit required for all customers unless you are able to provide a letter of credit from a previous utility provider.
Same day service fee is $96.00; next day or future date service fee is $48.00. Service fee and deposit will appear on first bill. Service requests will be processed based upon availability
Deposit can be waived with letter of credit from utility provider.
Please allow 45-60 days to receive your first utility bill.
A Two-Day Notice Is Required to Disconnect Service. Service requests will be processed based upon availability
E-mail notification will be sent within 24 hours of activation. If you do not receive notification, please contact Customer Service at the number below.

(928) 453-4146

BUSINESS NAME

*Required

RESPONSIBLE PARTY

LAST NAME

*Required

FIRST NAME

*Required

DATE OF BIRTH

*Required

DRIVERS LICENSE NO.

*Required

PLEASE ATTACH A VALID STATE OR GOVERNMENT PHOTO ID

*Required

SERVICE ADDRESS

*Required

MAILING ADDRESS (STREET NO. & STREET NAME)

*Required

MAILING ADDRESS (CITY)

*Required

MAILING ADDRESS (STATE)

*Required

MAILING ADDRESS (ZIP CODE)

*Required

PRIMARY PHONE

*Required

SECONDARY PHONE

E-MAIL ADDRESS

*Required

*There is a $100.00 deposit required for all customers unless you are able to provide a letter of credit from a previous utility provider.

ATTACH A LETTER OF CREDIT (IF APPLICABLE)

DATE SERVICE TO BEGIN

*Required

Your first bill will be sent to you by mail.
$96 fee applies to same day service requests.
Same day service requests must be made by 12 noon MST and will be processed based upon availability.
All other service requests will be scheduled for the next available business day.
Service requests are completed Monday through Friday 8 am to 5 pm, excluding City holidays.

I have read and agree to the above information.

(This field is required)

PREVIOUS SERVICE LOCATION (LOCAL SERVICE ONLY)

ARE YOU THE PROPERTY OWNER?

Yes
No

IF NOT, LIST LANDLORD/PROPERTY MANAGER

ATTACH COPY OF RENTAL AGREEMENT

EMERGENCY CONTACT

NAME

RELATIONSHIP

PHONE

City Regulations State:

I have read and understand the City regulations governing these utility services and charges.

(Required field)

*If the submit button does not work properly, make sure all required fields have been completed on this application.

QUESTIONS OR COMMENTS

(928) 453-4146 cscounter@lhcaz.gov