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2. 
4. Bulk Water Application
6. Company Name
7. Date:
9. Name
10. Email Address
12. Billing address
14. City
15. State
16. Zip Code
18. Phone Number
19. Fax Number
21. Dates of Usage:
22. Quantity requested/Tank Size:
24. Type of Vehicle/License number:
26. Bulk water rates:
28. $10.00 per 1,000 gallons
29. $25.00 minimum charge per load
31. Note: In determining whether residential or non-residential bulk water rates should be charged, the delivery destination shall be controlling
33. Hydrant meter deposit : $1600. lg. meter or $400. sm. meter
34. ___________________________
36. If using a hydrant meter - Start Read________________End Read____________________
38. Approved by:_______________________________________
40. 
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

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