New Hope Waterworks Form - Existing 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 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. In the event I breach this contract by refusing or failing, without just cause, to connect to the system, I agree to pay the minimum monthly rate for a period of five (5) years or the term of the FmHA loan, whichever is more in consideration of having the service made available to my property. I understand that unpaid bills shall constitute a lien upon my real estate and legal action can be pursued to collect the delinquent charges. In the event a suit is filed, for the collection of any unpaid bills, reasonable attorney fees and costs shall be added to the balance due for water service rendered in venue of Wayne County. 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 at the Corporation's expense 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
