Set Up New Service

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Lake Medina TT

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Setup A New Service Application

Address for Service Request

First name

Last name

Telephone Number

Date to Begin Service (mm/dd/yyyy)

Rent or Own?

Billing Address

Please provide lease agreement, closing disclosure, or management agreement. (.jpg or .pdf format)

Your Email

Previous Address

Previous Address - City, State Zip Code

Please provide photo of ID/license. (.jpg or .pdf format)

Additional Comments

The District requires a security deposit and application fee to setup service. Payment options will be emailed to you.

Agree

RULES FOR SERVICE

Service Agreement must be signed
Membership fee for owners – homeownership, for renters – $200
Administration fee – $25 for all residents
Bills are mailed on the 1st and payable upon receipt or by 5pm on 20th of the month
Make payments to Set Up New Service Water Sewer Supply Corporation P.O. Box 222222
Payments received after 5p.m. on the 20th of the month are assessed a 10% late charge
Termination results in a $25 disconnect fee and a $25 re-connect fee plus all account balances
Service will be terminated if payment is not received by last day of month
If service is terminated due to non-payment, we must receive payment by 12p.m. for water to be reinstated the same day
$75 Tampering fee is applied if meter has been tampered with
$35 “Return Check“ fee is applied for all returned checks
Frequent returned checks will require Credit Card Payments only
WWUI offers online payment via the web page, electronic and credit cards will be accepted
Moving without 30 day notice will result in forfeiture of deposit
Phone number for any problems with billing or water service –

I HAVE READ AND UNDERSTAND THE ABOVE RULES

Agree

Agreement

SERVICE AGREEMENT
Set Up New Service Water Sewer Corporation is responsible for protecting the drinking water supply from contamination or pollution which could result from improper system construction or configuration on the retail connection owner's side of the meter. The purpose of this service agreement is to notify each customer of the restrictions which are in place to provide this protection. The public water system enforces these restrictions to ensure the public health and welfare. Each retail customer must sign this agreement before Set Up New Service Water Sewer Corporation will begin service. In addition, when service to an existing retail connection has been suspended or terminated, the water system will not re- establish service unless it has a signed copy of this agreement.
PLUMBING RESTRICTIONS
The following unacceptable practices are prohibited by State regulations.
1. No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air-gap or an appropriate backflow prevention device.
2. No cross-connection between the public drinking water supply and a private water system is permitted. These potential threats to the public drinking water supply shall be eliminated at the service connection by the installation of an air-gap or a reduced pressure-zone backflow prevention device.
3. No connection which allows water to be returned to the public drinking water supply is permitted.
4. No pipe or pipe fitting which contains more than 0.25% lead may be used for the installation or repair of plumbing at any connection which provides water for human use.
5. No solder or flux which contains more than 0.2% lead can be used for the installation or repair of plumbing at any connection which provides water for human use.
SERVICE AGREEMENT
The following are the terms of the service agreement between Set Up New Service Water Sewer Corporation (the Water System)
1. The Water System will maintain a copy of this agreement as long as the Customer and/or the premises is connected to the Water System.
2. The Customer shall allow his property to be inspected for possible cross- connections and other potential contamination hazards. These inspections shall be conducted by the Water System or its designated agent prior to initiating new water service; when there is reason to believe that cross- connections or other potential contamination hazards exist; or after any major changes to the private water distribution facilities. The inspections shall be conducted during the Water System's normal business hours.
3. The Water System shall notify the Customer in writing of any cross- connection or other potential contamination hazard which has been identified during the initial inspection or the periodic re-inspection.
4. The Customer shall immediately remove or adequately isolate any potential cross-connections or other potential contamination hazards on his premises.
5. The Customer shall, at his expense, properly install, test, and maintain any backflow prevention device required by the Water System. Copies of all testing and maintenance records shall be provided to the Water System.
ENFORCEMENT
If the Customer fails to comply with the terms of the Service Agreement, the Water System shall, at its option, either terminate service or properly install,test, and maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement of this agreement shall be billed to the Customer

I HAVE READ AND UNDERSTAND THE ABOVE AGREEMENTS

Agree

Statement of Responsibility
It is the customer's responsibility to ensure that the home is prepared for water service. Any leak after the meter, or inside the home, or damages arising from a leak or fixtures left open inside the home, will be the customer's responsibility.

I have read and accept the Statement of Responsibility

Agree

Applicant’s failure to adhere to all requirements contained in the District’s Rate Order may result in fines, penalties, and a delay or denial of service. A copy of the District’s Rate Order is available upon request.

Agree

Electronic Signature Agreement
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide the District or in accessing or making any transaction regarding any agreement, acknowledgment, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and the District. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature in obtaining a district facilitated service constitutes your agreement to be bound by the terms and conditions of the Service Agreement of the District.

Agree

Today's Date (mm/dd/yyyy)

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