Click here for PDF version. Fairfield Rural Waterworks - Renter Form Owner Name(Required) First Last Renter Name(Required) First Last Service Address 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 Landowner Consent(Required) AgreedAs landowner, I hereby grant permission for my renter to pay a renters deposit for water service at the address listed above and to be placed in the renter's name. By signing this permission form, the renter becomes responsible for water charges.Renter's Agreement(Required) I agreeAs renter, I agree to become a customer of the system and to pay the renters deposit required by the rules and regulations to be adopted by the governing board. In the event that I move or discontinue service with Fairfield Rural Waterworks, the renters deposit will be refundable to me in the case that my account is in good standing, with a zero balance. 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 my initial deposit fee. Should I desire service at some time later, I understand that I must pay the current connection fee. I further understand that legal action can be pursued to collect any delinquent charges.Applicant Electronic Signature (Full Name)(Required)
