Granite Oaks Water Users Association Application for Service

Print this form and mail with payment to address below

Granite Oaks Water Users Association
P.O. Box 4947
Chino Valley, AZ 86323

Telephone 928-583-0655
Fax: 928-636-9771

The undersigned customer applies for water service at the indicated location. This water service is provided by Granite Oaks Water Users Association, Inc., subject to the rates, charges, rules and regulations established by the Arizona Corporation Commission. G.O.W.U.A will make available, upon request within 60 days from receipt of the request, a summary of G.O.W.U.A rate schedule or a copy of the Arizona Corporation Commission Rules and Regulations governing deposits, advances, service termination, billing and collection and complaint handling.

In consideration for the provisions of water service the customer agrees to pay the following charges:

Basic Service Rate:
5/8”x3/4” meter
1” meter

Minimum Monthly Charge:
$20.00
$50.00

The above amounts cover the first 1000 gallons and usage is billed at $2.00 per 1000 gallons thereafter. Payable monthly. Larger meters have higher monthly minimum charges. Call the business office for rates.


New Meter Installation:
Service Establishment Fee (Non-refundable)
Installation Charge - 5/8”x3/4” meter
          (Refunded over a 10-year period to occupant)

Sales Tax
Total

Transfer:
Service Establishment Fee (Non-refundable)
Sales Tax
Total

Other Charges:
Refundable Deposit
After-Hours Establishment
Re-Connect (Delinquent)
Meter Test (If Correct)
Meter Re-Read (If Correct)
N.S.F. Check



$ 25.00
$250.00



$ 1.59
$276.59


$25.00
$ 1.59
$26.59


$50.00
$50.00
$20.00
$20.00
$10.00
$15.00


Name:_____________________________________________________________ Phone:______________________

Service Address:____________________________________________________ Tax Parcel #:__________________

Subdivision: Granite Oaks______    Royal Oaks______    Granite Oaks Estates______ Lot #:_____________________

Billing Address:

Name:______________________________________________________________________________

City, State, Zip:_______________________________________________________________________

Date Service Requested:_____________________ Date Turnoff Requested:______________________

Do you own______  or rent______?    Social Security #__________-________-__________

Emergency Contact:___________________________________________________________________

Do you have a fire sprinkler system?     YES_______NO_______

Do you have a private well?     YES_______NO_______

Signature:___________________________________________________________________________

                  Please remit payment with form

* Call the business office for rates on larger meters.