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Customer Service - Start Canal Water / Authorization of Agent

  1. Water District
  2. Coachella Valley Water District
    Canal Water Service Request - Authorization of Agent (CVWD-106)





  3. Property Owner Telephone Number Type*
  4. Is the billing information the same as above?*
  5. Billing Telephone Number Type*
  6. Are you the new owner of the property?*
  7. Will existing users stay on the account?*
  8. Will you be leasing the property?*
  9. Is a well located on your property?*
  10. Active?*
  11. Abandoned?*
  12. Will you be multicropping?*
  13. Water will be used for: (check all that apply)*




    Note:  Industrial Hemp cannot be irrigated with Federal canal water at this time. Any applications for canal water service with Industrial Hemp as a crop will be denied until further notice.

  14. Parcel Information*
    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.

  15. Water Orders*
  16. Terms & Conditions*

    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 $46 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.

  17. CVWD Use Only
  18. New Meter Sequence:

  19. Additional User:

  20. Refund Agreement Number:

  21. Last Date Meter Used:

  22. Lateral Remarks:

  23. Notes:

  24. Customer Service - Processed By & Date:

  25. Customer Billing - Processed By & Date:

  26. Zanjeros - Processed By & Date:

  27. Customer Billing - Processed By & Date:

  28. COACHELLA VALLEY WATER DISTRICT

    Post Office Box 1058

    Coachella, California 92236

    (760) 391-9600

    (760) 398-3190 - fax

    CustomerService@cvwd.org


    rev 10/2021

  29. Leave This Blank:

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