Service Address * Start Date (agreement date) * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2023202420252026 Should be legal move in date of tenant. If there is a discrepancy staff may need to contact you. Applicant Name (First) * Applicant Name (Last) * Additional Contact Name Billing Address (if different) Phone Number * E-mail * Owner Name & Phone * Electronic Acknowledgement * By checking this box, the applicant requests the San Lorenzo Valley Water District to furnish water service to the premises noted above and agrees to pay the rates in effect applicable for the services rendered; and agrees to abide by the rules and regulations affecting said service. A $20 new account fee will be charged to establish service. A $75 deposit will be charged, refundable upon one year of good payments. These will be on the next bill. If your account is past due, a notice may be sent to the owner. Should your water be turned off for non‐payment, a notice will be sent to the owner and it will result in termination of your account. Electronic Acknowledgement Leave this field blank
