Foothills Utilities
13157 E 44th St, Yuma, AZ 85367
928-342-1238
info@foothillsutilities.com

Service Application
Service Applying for (required)
WaterSewer
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)

PIN (6-digit numerical) (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

Emergency Contact First Name (optional)

Emergency Contact Last Name (optional)

Emergency Contact Phone (optional)

Are you the property owner? (required)
YesNo

Additional Comments (optional)

I, the undersigned, hereby make application to Foothills Utilities for Water and/or Sewer Service, and agree that if my account under this Agreement and/or any other prior or present Water and/or Sewer Service Agreement with Foothills Utilities is not paid promptly when due, and Foothills Utilities deems it necessary to resort to collection agencies or attorneys to collect the amount of the account, the applicant and/or his or her representative agree to pay a fifty percent (50%) collection fee and one and one-half percent (1 1/2%) interest per month on the unpaid balance and all cost and attorney fees in connection therewith. I agree to pay for such services at regular published rates and-in accordance with rules and regulations, all as approved by the Arizona Corporation Commission, which are made a part hereof. I agree to use such service for my own purposes and agree not to sell or donate any part of it or permit it to be used for any other purposes. I agree that duly authorized agents and employees of said Foothills Utilities shall have access to my Premises at all reasonable hours for the purpose of installation or removal of meters and inspection of equipment incidental to carrying out the Agreement. I further agree to hold Foothills Utilities harmless from any claims, real or alleged, for loss or damage to property or persons arising out of the delivery of services beyond the point of metering. I agree to give Foothills Utilities written notice when I cease to occupy said premises and I desire service discontinued. In the event of failure on my part to comply with the terms and conditions of this Agreement and/or any other prior or present Agreement with Foothills Utilities, I agree that Foothills Utilities or its representative, may discontinue service hereunder without further notice to me, and that such discontinuance will not constitute waiver of any claims against me for prior service at any location rendered hereunder by Foothills Utilities.

Today’s Date (required)

Please write your signature in the box below (required)

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

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