Application for Service / Customer Information
Email *
Date of application *
MM
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YYYY
Date you purchased or leased the property. *
MM
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Name of Applicant *
I request metered water service from Great Basin Water Company and agree to abide by all applicable Rules and Regulations. Rules and Regulations *
Required
Applicant type *
Service Address / City / State / Zip *
Mailing address if different
Phone Number *
Email address *
Emergency Contact (Name and Phone) *
  Landlord Name (if applicable)  
  Landlord Phone (if applicable)  
  Landlord Mailing Address (if applicable)  
  Landlord Email Address (if applicable)  
  Once the application is submitted, water service will be connected within 48 hours.   If the property is leased and the tenant fails to pay for water service, the property owner will be held responsible for any outstanding balance. 
  Type your full name as your electronic signature.   *
Date of Signature *
MM
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DD
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YYYY
Submit
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