New Hope Waterworks Registration - New Member/New Service Applicant Name(Required) First Last 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 I desire service for my:(Required) Home Business Farm Service Agreement(Required) I agreeI agree to pay New Hope Waterworks their required hook up fee. I will be billed for the meter and well, plus contractor fees by the contractor. I understand that my water service may be disconnected if I do not pay the contractor in full within their terms. I agree to become a customer of the system as soon as service is available to my property and pay the charges required by the rules, rates, and regulations adopted by the governing board. I hereby agree to give to New Hope Waterworks Corporation such easement over my land as is necessary to lay, repair, maintain, or replace a water line or lines for said water distribution system. Said easement shall not exceed fifteen feet in width. I agree that the equipment installed to the meter including the meter shall remain the property of the Corporation and may be removed upon the termination of this contract for service.Applicant Electronic Signature (Full Name)(Required) Date(Required) MM slash DD slash YYYY
