Service Application Utility (required) —Please choose an option—Foothills YumaFoothills Kingman Service Applying for (required) WaterSewer Winter Visitor? (required) YesNo Connect Date (required) First Name (required) Last Name (required) Spouse/Roommate First Name (optional) Spouse/Roommate Last Name (optional) Cell Phone (required) Home Phone (optional) Email (required) Create a 4-digit Account PIN (required) Service Address (required) City (required) State (required) —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code (required) Billing Address Same as Service Address? (required) YesNo Billing Address (required) City (required) State (required) —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code (required) Emergency Contact First Name (optional) Emergency Contact Last Name (optional) Emergency Contact Phone (optional) Are you the property owner? (required) YesNo Escrow # (required) Additional Comments (optional) Landlord/Property Mgr. (lease agreement and deposit will be required.) (required) I acknowledge Foothills Utilities requires up to three (3) business days to establish or discontinue service accounts, once all necessary information is provided and applicable fees are paid. A security deposit may be required, in addition to any applicable service fees. Proof of occupancy, such as a lease, escrow number, or deed, will also be required. I agree to pay any outstanding charges from previous accounts before service can be established. I acknowledge and agree to pay for services at the approved tariff rates, in accordance with the rules and regulations as authorized by the Arizona Corporation Commission. I agree to provide written notice to Foothills Utilities when I cease to occupy the premises and wish to discontinue service. In the event of my failure to comply with the terms and conditions of this Agreement, or any other prior or current agreement with Foothills Utilities, I understand that further action may be taken. Today’s Date (required) Please write your signature in the box below (required) Clear I acknowledge my signature indicates that I have read and accepted the above agreement, and that all the information I have provided is correct. (required) Yes Δ We're here to help! Need more assistance? We’re here to help 24/7. Click here Foothills Utilities Test v2!
