Form Center

2. City Name*
4. First Name*
5. Last Name*
7. Title*
9. Mailing Address*
11. City*
12. Zip Code*
14. Email Address*
16. Phone Number*
18. KEEP IN MIND the larger gallon quantities for commercial rates. INCLUDE any monthly base or service fee in the total monthly costs.
20. Does the city provide and bill for water service?*

    1. Yes
    2. No
22. Who is the water service provider?
24. Number of water customers?
26. Monthly Residential Water Use for 5,000 gallons (based on 3/4-inch water meter)*
    example: $30.50
28. Monthly Residential Water Use for 10,000 gallons (based on 3/4-inch water meter)
    example: $50.25
30. Monthly Commercial Water Use for 50,000 gallons (based on 2-inch water meter)
    example: $126.15
32. Monthly Commercial Water Use for 200,000 gallons (based on 2-inch water meter)
    example: $801.00
34. Average Monthly Residential Use in gallons (per residence)
    example: 5,200 gallons
36. Does your city provide and bill for wastewater service?*

    1. Yes
    2. No
38. Number of wastewater customers?
40. Monthly Residential Wastewater Use for 5,000 gallons (based on 3/4-inch water meter)
    example: $26.13
42. Monthly Residential Wastewater Use for 10,000 gallons (based on 3/4-inch water meter)
    example: $46.20
44. Monthly Commercial Wastewater Use for 50,000 gallons (based on 2-inch water meter)
    example: $76.11
46. Monthly Commercial Wastewater Use for 200,000 gallons (based on 2-inch water meter)
    example: $174.24
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field