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Customer Service - Other Requests

  1. Water District

  2. Coachella Valley Water District

    Other Customer Service Requests

  3. Please select the service type and complete the required fields marked with an asterisk (*).*

    I want to...

  4. Date to Stop Service should be within two weeks of submitting this request.
    Selection of a stop service date does not guarantee a date of service.
    Your request will be confirmed within 2 business days of submittal.

  5. Reason for Terminating Service*

  6. Update My Account Information (WS-115)

    Select type of account*

  7. This request is to:
    (Please select all that apply)

  8. 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.

  9. 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.

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

  11. 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?

  12. 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.

  13. Primary Telephone Type*

  14. Secondary Telephone Type

    Post Office Box 1058
    Coachella, California 92236
    (760) 391-9600
    (760) 398-3190 - fax

    rev 2/2020

  16. Leave This Blank:

  17. This field is not part of the form submission.