Application for Water Service

CHRISTMAS VALLEY DOMESTIC WATER SUPPLY DISTRICT

87379 Holly Lane

PO Box 142

Christmas Valley, OR 97641

Phone and Fax: 541-576-2090

Please Print Clearly

Name: _______________________________ Have you had service with us before? ______

Mailing Address:	Physical Service Address:

______________________________________ _______________________________________________

Phone: ________________________________ Date to begin Service: ______________

Type of Service: ___ Residential ___ Commercial ___ Out of District ___ Special Rate ___

Would you prefer to receive your bills via email? Yes	NO

E-mail Address: ___________________________________________________

Residential rate for water service is $76.00 per month.

Commercial rate for water service is $80.00 per month.

A deposit equal to two months charge for water service is required for all accounts. The Deposit will be held until the account is closed.

Deposit Amounts-

Residential- $152.00

Business- $160.00

If water service is turned off for non-payment, a $10.00 service charge and the balance of the account must be paid before water service is resumed.

Normal business hours service call fee is $10.00 and after hour's service call fee is $50.00.

In signing this application, the applicant agrees to abide by all the district’s Ordinances, Rules, Regulations and Restrictions concerning the water system of the Christmas Valley Domestic Water Supply District. An application constitutes a written request for service and does not bind District to provide water service.

Signature: ________________________________ Date: ____________________

**New Installation/Connection Fees **

Basic Installation	$3000.00 + Deposit

Under the Road Installation (Non-County) $4,500.00 + Deposit

Residential with County Road Bore $11,000.00 + Deposit

Type of service line used- __________________________________________________

*****If additional costs for connection are incurred by the Water District, customer will be billed for those costs. Customer will have 30 days to pay additional charges in full. Installations will take time to get in, this process will take 1-2 months per install that we have in line. We will let you know on payment how many installs are ahead of you. We understand that you want your service in fast and will do everything we can to get it in in a timely manner.

Signature:___________________________________ Date: _______________________