Applicant Name(Required) First Last Business Name Address(Required) Street Address Address Line 2 City State 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 ZIP Code Have you ever had service with McMinnville Water & Light?(Required) Yes No Auto Draft Payment MethodPlease type initials. A voided check is required for Smartbill. Vehicle License Plate Number(Required) Driver's License or ID(Required) Employer Phone Number(Required)Email Fee Acknowledgement & Agreement(Required) By checking the box, customer acknowledges a Customer Processing Charge of $28.00 will be added to your first bill. Consent(Required)(Falsification of information can be used as justification for termination of credit agreement.) *Social Security number will be kept confidential pursuant to ORS 192.502(2), ORS 192.502(4). Social Security number may be used to collect delinquent accounts in our collection process, as necessary. Customer information procedures are established in MW&L Customer Policies as approved by the MW&L Commission. I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Customer Electronic Signature (Full Name)(Required) Bulk Water Terms of Agreement (1) Customer agrees to read and adhere to McMinnville Water & Light’s (MW&L) Bulk Water Fill Station (BWFS) Operating Instructions. (2) MW&L is providing potable water up to the Point of Delivery. The Point of Delivery is defined as the outlet hose coupling at the bulk fill station hydrant. MW&L makes no guarantee of water quality beyond this point due to variables beyond MW&L’s control including but not limited to: Customers hoses, connections, portable tank, transfer connections, storage tank, and flushing time of connection hoses. (3) MW&L is not responsible for failure of Customer’s hoses and connection devices. (4) Customer will not add or mix any substance to the water while connected to the BWFS. (5) Customer agrees to not block traffic or existing driveways when using the BWFS. (6) Customer will contact MW&L immediately to report all damages prior to connecting and drawing water. (7) Customer accepts responsibility for all direct damages to the Bulk Water Fill Station and any associated damages caused by Customer’s abuse, misuse, or vandalism. (8) A camera has been installed to provide additional security. MW&L will deactivate service to any customer who abuses our system. (9) Customer agrees to pay MW&L for all water usage and the monthly customer charge according to the McMinnville Water & Light Rate Schedule W-4. (10) Customer understands that the electronic card will not be issued if any Customer accounts are not in good standing. Customer’s electronic card will be deactivated according to MW&L Customer Policies for Involuntary Disconnection of Service. Such Customers must pay all monies due by them before MW&L will issue or reactivate the electronic card(s). (11) Customer will refer to MW&L Customer Service Policies for security deposit requirements of a General Service Customer. (12) Customer understands that the electronic card is issued solely to the Customer. Customer is not authorized to allow anyone else to access their assigned electronic card. (13) MW&L will provide the first electronic card for free. Any additional electronic cards will cost $25.00 and must be paid for prior to issuing. (14) Customer will immediately notify MW&L if electronic card has been lost or stolen. The customer will be responsible for any water usage up until the point of notification. A replacement card will cost $25.00 and must be paid for prior to issuing. (15) Customer will be responsible for completing the water usage report at the BWFS each and every time of use. If Customer does not comply with this policy, MW&L will charge the customer for unaccounted water usage. (16) Customer must call to cancel service. Customer is responsible for all charges up until the date of cancelation. MW&L will deactivate the electronic card on the date of notice. (17) Customer will be held liable for any violation of this agreement up to and including cancelation of the Bulk Water Fill Station use.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
