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{}
W10=
*
Are you the property owner or a tenant?
*
Are you the property owner or a tenant?
Property Owner
Tenant/Renter
*
Street Address of Service Location
*
Date to Begin Service (Lease Date or Close of Escrow)
*
First Name
*
Last Name
Business Name (If Applicable)
*
Primary Phone Number (Include Area Code)
*
Is your primary phone a mobile phone or landline?
*
Is your primary phone a mobile phone or landline?
Mobile Phone
Landline
Secondary Phone
Is your secondary phone a mobile phone or landline?
Is your secondary phone a mobile phone or landline?
Mobile
Landline
*
Email
Billing Address (If Different from Service Address)
Name of Additional Authorized Access User 1
Name of Additional Authorized Access User 2
*
Certify
*
Certify
I certify that am the above-named individual and agree to comply with the District's Administrative Code
Administrative Code
https://www.svwd.org/media/Programs-Policies-Admin_Code/Administrative_Code.pdf
Submit
Submit Form
/frontend_forms/resumable_upload/
X
Confirm
Cancel
