Canal Water Service Request - Authorization of Agent (CVWD-106)
This Canal Water Service Request – Authorization of Agent form must list the parcel and all additional parcels served by the above meter. This will allow for the proper application of paid Canal water charges to each parcel to which water is actually being delivered.
CREDIT WILL NOT BE GIVEN TO PARCELS NOT LISTED ON THIS FORM OR TO PARCELS TO WHICH WATER IS NOT ACTUALLY DELIVERED.
I hereby authorize the above named water user, if any, and his/her designees to sign or give orders to Coachella Valley Water District for the delivery of water through this meter. By signing this document, I certify I am the legal property owner for the parcels identified within this application; all information is true and correct. I assume all responsibility for any bills, costs, loss, damage, penalties, charges, or fees associated with this meter under the Regulations of the District. This authorization shall be revocable at any time upon written notice to the District. A $30 Account Establishment Fee will appear on my first bill. I acknowledge and agree to comply with all District Regulations, Ordinances, Policies and Rules, and amendments thereto. Where the demand for water exceeds the available water supply, water orders may be delayed except under emergency conditions as determined by the District. Service may be interrupted for the purpose of repair and maintenance at any given time.
COACHELLA VALLEY WATER DISTRICT
Post Office Box 1058
Coachella, California 92236
(760) 398-3190 - fax
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