BMWC Application – Big Mountain Water Company

Application for Big Mountain Water Company

Big Mountain Water Company Application for Service

Service Request Type

NEW SERVICE/NEW CONNECTION ($500.00 FEE)

EXISTING SERVICE (NEW OWNERSHIP)

PROPERTY SERVICE ADDRESS

PROPERTY SERVICE PHONE

OWNER BILLING INFORMATION

First Name

Last Name

Business Name (if applicable)

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone Number - Work/Home/Cell

Secondary Email (optional)

How would you like to receive your statement? (Choose One):

Postal

Both

Does this property use a management company?

Yes

Property Management Company

Company Contact

Phone Number

Company Email

EMERGENCY CONTACT INFORMATION

First Name

Last Name

Contact Phone Number

Contact Email

Is there a secondary emergency contact?

Yes

SECONDARY EMERGENCY CONTACT INFORMATION

First Name

Last Name

Contact Phone Number

Contact Email

DIRECT WITHDRAWAL INFORMATION

If you choose to enroll in direct withdrawal, please additionally download, fill out and return the following PDF or call us to arrangement alternative set up.

Application for Direct Withdrawal PDF

By typing my digital signature below, I confirm that all information provided is accurate and complete.

Digital Signature