Application and Agreement For Residential Water / Wastewater Service

The undersigned “Customer” requests utility service at the described service address (“premise”) from “Company” (Liberty Utilities) and agrees to be governed by and comply with all applicable laws, rules, regulations, tariffs and orders governing such services as they may be, from time to time, amended. Customer also agrees:

To assume responsibility for installing, inspecting, maintaining and repairing any piping or other water facilities on Customer’s side of the meter; to make certain all water-using facilities are turned off before water service is started; to safeguard all Company property installed in or on premises; to ensure all Company property (including meter) in or on the premises is unobstructed and accessible to Company.
Company is not responsible for any damages to the premises from flooding due to condition of water facilities or appliances on Customer’s side of meter or for negligence of third person or forces beyond the control of Company resulting in any interruption of service or damages to Customer or Customer’s premises. Company does not guarantee uninterrupted service or service at a specific water pressure or gallons per minute flow rate.
Meters will be read and bills rendered monthly. Bills are due when rendered. Failure to receive bills or notices shall not prevent such bills from becoming delinquent, nor relieve the Customer of his obligations.
Deposit is required before service can be provided. (Cash, Check, Money Order, or Credit Card accepted).

*Required fields

Start Service Request

Date Applied (mm/dd/yyyy)*

Service Start Date - Please allow a minimum of 2 business days for the start date *

Ownership*

Owner

Tentant

First Name*

Last Name*

Spouse

Co-applicant

Place of Employment*

Telephone Home*

Telephone Cell

Telephone Work

Date of Birth*

Driver's License#*

Driver's License State of Issuance*

Service Address*

City*

State*

Community*

Zip Code*

Mailing Address (if different)

State

City

Zip Code

E-mail*

I would like my monthly bill to be delivered by:*

Paperless

Paper Bill

E-Bill, our paperless billing program, is a way to electronically receive your bill each month. An email will be sent to the email address you provided above to notify you when your bill is available for secure viewing online.

I agree*

Under penalties of perjury I declare that to the best of my knowledge and belief the above information is true correct and complete.

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Application and Agreement For Residential Water / Wastewater Service