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Customer Service - Other Requests

2. 
3. Coachella Valley Water District
   Other Customer Service Requests
   
   
   
   
   
   
5. Please select the service type and complete the required fields marked with an asterisk (*).*

   
   

   I want to...

   1. Stop Service at a Residence Property
   2. Stop Service at a Commercial Property
   3. Update My Account Information
7. Stop Service Request (WS-95S)
   
   Stop Service Date*
   Stop Service Request (WS-95S)
   
   Stop Service Date

   Date to stop service should be no more than two weeks in the future of submitting this request.  We are unable to stop service for a past date.

   The request of a stop service date does not guarantee a date of service.

   Your request will be confirmed within 2 business days of submittal.

9. Account Number - First 6 Digits*
10. Account Number - Second 6 Digits*
12. First Name*
13. Last Name*
15. Service Address Line 1*
17. Service Address Line 2
19. City*
    -- Select One --Cathedral CityDesert Hot SpringsIndian WellsIndioLa QuintaMeccaNilandPalm DesertRancho MirageSalton CitySky ValleyThermalThousand Palms
20. Zip Code*
22. Telephone Number*
23. Email Address*
25. Forwarding Address Line 1*
27. Forwarding Address Line 2
29. City*
30. State or Province*
31. Zip or Postal Code*
33. Reason for Terminating Service*

    1. Owner - Sold Property
    2. Owner - Renting to Tenant
    3. Owner - Tenant Moving; Revert to Owner Name

    1. Tenant - Moving Out
    2. Other - Please explain:
35. Other*
37. By typing or signing my name below, I verify that I am authorized to make updates to this Coachella Valley Water District account.*
39. Update My Account Information (WS-115)
    
    Select type of account*

    1. Residential Owner
    2. Residential Tenant
    3. Commercial Owner
    4. Commercial Tenant
41. Account Number - First 6 Digits*
42. Account Number - Second 6 Digits*
44. Account Holder's First Name*
45. Account Holder's Last Name*
47. Service Address Line 1*
49. Service Address Line 2
51. City*
52. Zip Code*
54. Telephone Number*
55. Email Address*
57. This request is to:
    (Please select all that apply)

    1. Change the mailing address
    2. Change the name on the account (same person, new name)
    3. Provide new or updated emergency contact / authorized agent information
    4. Authorize a tenant to establish service in their name or Remove a tenant from authorization
    5. Add or update the secondary applicant name
    6. Add or update the primary telephone number
    7. Add or update the primary email address
59. Property Owners are responsible for payment of water bills. By acknowledging this document, I certify I am the legal landowner or designee of the property identified as the service address above, all information is true and correct, and acknowledge and agree to all terms and conditions set forth below. I assume all responsibility for any bills, costs, loss, damage, penalties, charges, or fees associated with water service regardless of user or use.
    Owners may authorize tenants to establish service in their names; however, responsibility for the account remains with the Property Owner. The District, as a courtesy, may allow the Property Owner to authorize a Tenant to be billed for service. This courtesy is at the discretion of the District and as such, the District may transfer service from a Tenant back to the Property Owner and refuse to allow future service to be billed to a Tenant. In such circumstances, the Property Owner will receive all billing statements. CVWD may require Property Owners to pay any outstanding balances prior to a new Tenant establishing service. Upon termination of the tenant’s account, the account will automatically revert to the owner’s name. I understand all bills are due and payable within 15 days of billing. Bills not paid within 25 days of billing are assessed a 1.5% Late Charge. Bills not paid within 40 days of billing are assessed a $25 Delinquency Fee. *

    1. I acknowledge and agree to comply with all District Regulations, Ordinances, Policies and Rules, or amendments thereto.
61. New Mailing Address Line 1*
63. New Mailing Address Line 2
65. City*
66. State or Province*
67. Zip or Postal Code*
69. If this is a seasonal address change, please indicate the start and end dates:
    If this is a seasonal address change, please indicate the start and end dates: Start Date

    —

    If this is a seasonal address change, please indicate the start and end dates: End Date
71. Previous First Name*

    Note: This is limited to a name change for the same person only. Please submit an application for service for a new property owner or tenant.

72. Previous Last Name*
74. New First Name*

    Note: This is limited to a name change for the same person only. Please submit an application for service for a new property owner or tenant.

75. New Last Name*
77. Emergency Contact / Authorized Agent*

    Person authorized to access your account information and act on your behalf. Input "none" if no one is authorized.

79. Emergency Contact / Authorized Agent Telephone*
80. Emergency Contact / Authorized Agent Email Address*
82. Authorization for Tenants to Establish Service*

    As the Residential or Commercial Property Owner, do you authorize current and future tenant(s) to establish service in their name?

    1. Yes, I authorize a tenant to establish service in their name. I understand that a residential or commercial tenant will be required to submit their request to start service.
    2. No, I do not authorize a tenant to establish service in their name. This account will be held in the property owner's name only.
84. Responsibility for Payment of Water Bills

    Property Owners are responsible for payment of water bills.
    
    By acknowledging this document, I certify I am the legal landowner or designee of the property identified as the service address above, all information is true and correct, and acknowledge and agree to all terms and conditions set forth below. I assume all responsibility for any bills, costs, loss, damage, penalties, charges, or fees associated with water service regardless of user or use.
    
    Owners may authorize tenants to establish service in their names; however, responsibility for the account remains with the Property Owner. The District, as a courtesy, may allow the Property Owner to authorize a Tenant to be billed for service. This courtesy is at the discretion of the District and as such, the District may transfer service from a Tenant back to the Property Owner and refuse to allow future service to be billed to a Tenant. In such circumstances, the Property Owner will receive all billing statements. Upon termination of the tenant’s account, the account will automatically revert to the owner’s name.
    
    I understand all bills are due and payable within 15 days of billing. Bills not paid within 25 days of billing are assessed a 1.5% Late Charge. Bills not paid within 40 days of billing are assessed a $25 Delinquency Fee.

    1. I acknowledge and agree to comply with all District Regulations, Ordinances, Policies and Rules, or amendments thereto.
86. Secondary Applicant First Name*
87. Secondary Applicant Last Name*
89. Primary Telephone Number*
90. Primary Telephone Type*

    1. Cell phone
    2. Home
    3. Work
92. Secondary Telephone Number
93. Secondary Telephone Type

    1. Cell phone
    2. Home
    3. Work
95. Email Address*
97. By typing or signing my name below, I verify that I am authorized to make updates to this Coachella Valley Water District account.*
99. COACHELLA VALLEY WATER DISTRICT
    Post Office Box 1058
    Coachella, California 92236
    (760) 391-9600
    (760) 398-3190 - fax
    CustomerService@cvwd.org
    
    rev 2/2020
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100. 1. Receive an email copy of this form.
101. Email address

     This field is not part of the form submission.

102. Submit Submit and Print

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