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Water Service Application Form

Form fields marked with * (asterisk) are Required

Please Enter Your First Name.

Please Enter Your Last Name.

Please Enter A Valid Social Security Number. Numbers and Hyphens Only.

Please Enter A Valid Email Address.

Please Enter The Service Address

Please Enter The Mailing Address

A Valid Phone Number is required. Dashes are allowed.

Please Enter Your Emergency Contact Name.

A Valid Emergency Number is required. Dashes are allowed.

Have you ever been on our water system?

Please Indicate Your Previous Water Service Status.

Please upload images of your Drivers License AND Proof of Ownership or Copy of your Lease Agreement. *
Acceptable formats: JPEG, PNG, GIF

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Terms & Conditions

This application for utility service, when executed, becomes a binding contract between myself or my representative (herein referred to as Customer) for the services provided by the City and constitutes an agreement to abide by the rules and regulations governing these services including timely payments and reasonable and diligent protection of utility metering and other equipment at the service location. Billing will be at current rates for class of service as adjusted periodically. Services are billed monthly stating the amount due, the delinquent date and the delinquent amount. Bills are mailed by the 1st (FIRST) of each month and are delinquent after the 15th (FIFTEENTH). All accounts not received in our office by the date indicated on the bill for any previous balance owed will be disconnected as per policy. Should this become necessary, there will be additional charges to cover the collection of the account. If legal action is necessary, collection costs, including a reasonable attorney fee will be added to the amount due. The City cannot be responsible for mail delivery. Failure to receive the bill will not relieve the customer of payment obligation. Returned checks will be regarded as unpaid bills. The Customer will be charged a service charge for each check returned. The meter, meter box, and lid DO NOT belong to the Customer, but remain the property of the City. Any damage inflicted to the meter, meter box or connecting lines from the main line to the meter will be billed to the Customer. Upon termination of service, deposits will be refunded to the Customer after final billings have been paid. The deposit refund check will be made payable to the name as it appears on the account. In accordance to the published rate ordinance, only one resident and/or business may be served from one water meter. The State Health Department requires a physical disconnect between any public water supply and private system. All customers are required to install a cut-off device on the service line between the water meter and residence and/or business, for those occasions when the customer wished to cut off their own water supply for repair, etc. Our service personnel will be happy to answer Customers’ calls or question and assist them with any problem pertaining to their water service. However, in the event the problem is found to be the Customer’s responsibility, the Customer may be billed for a service call if a trip to the service location is necessary. Any or all of the fees posted at the City are subject to change without prior or public notice. I (Customer) understand that I will be responsible for payments of billings. Water user shall pay a minimum bill from the date the water is available, even though the Customer may not avail themselves of the service. I (Customer) have read and understand the conditions of this service application and the rules and regulations of the City. I am of legal age and am authorized to execute this agreement.

Please Check the Agreement Checkbox.

Leak Adjustment Insurance

By indicating Yes on the Leak Adjustment Insurance Election Preference below, I hereby enter into this contract with the City of Cave Spring and agree to pay $2.00 per month for said Excessive Leak Insurance as billed. If insurance is not taken with application for service, then I have a (six) 6month grace period before the coverage is effective. I understand that the City can cancel the policy at any time, but will provide notice in the event this may occur. Bills not paid when due will result in termination of coverage under this policy. I understand that I must report a potential leak to the city immediately upon learning of a potential leak and make arrangements for repair of leak within in 10 days from becoming aware of leak. I understand that to file a claim I must fill out an Adjustment Request form and provide a copy of repairs to my water system as a result of the leak, along with any other information relative to the leak as requested by the City. The City will adjust the bill based on the policy if the leak qualifies under same. No more than two months’ charges will be adjusted in connection with a leak, and a maximum of $500 will be adjusted. Only one adjustment is allowed in any 12 month rolling period. I understand that I will not be entitled to an adjustment of my water bill in the event of a leak if I have not purchased the leak protection offered by the City.

I Elect To Have Leak Adjustment Insurance

Please Choose Your Leak Adjustment Insurance Preference.

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