Boyleston - Owner Owner Name(Required) First Last Phone(Required)I desire service for my: Home Business Farm Service Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent(Required) AgreedI agree to become a customer of the system and to pay the charges required by the rules and regulations to be adopted by the governing board. I agree that I am responsible for any and all additional costs higher than the initial hook-on fee. In the event I breach this contract by refusing or failing, without just cause, to connect to the system or pay the minimum monthly rate, I understand that I forfeit by initial connection fee. Should I desire service at some later time, I understand that I must pay the current connection fee. I further understand that the unpaid bills shall constitute a lien upon my real estate and legal action can be pursued to collect the delinquent charges.Applicant Electronic Signature (Full Name)(Required) Date(Required) MM slash DD slash YYYY
