Construction/hydrant meter

CONSTRUCTION/HYDRANT METER APPLICATION AND SERVICE AGREEMENT

Requirements with the City of Melissa: Register as a contractor Obtain a development permit Submit a $2,000.00 deposit
Date*

MonthDayYear
Date
Company Name/Applicant:*
Location of intended use:*
Authorized agent of Applicant/ Person Responsible for Bill Payment:*
Office number and or extension #*
Please enter a valid phone number.Format: (000) 000-0000.
Cell number:
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com

Mailing address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
On-site Foreman/Superintendent Responsible for Meter*
Cell number:*
Please enter a valid phone number.Format: (000) 000-0000.
Office number:*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Terms of Service Agreement:

By signing below, I agree and certify as follows: I have received a copy of and understand the minimum monthly billing charges and the billing procedures applicable to this account. The information provided on this application is true and correct. I agree to comply with all applicable laws, ordinances and regulations governing utility service and equipment provided to this account whether specified herein or not. I understand that the City of Melissa will obtain monthly readings from any meter associated with this application and that I am responsible for cooperating with the City of Melissa in its efforts to obtain monthly readings by, among other things, submitting all information requested by the City of Melissa on or before 4:30 p.m. on the 15th of every month. If the City of Melissa is unable to obtain monthly readings from a meter associated with this application for any reason, I agree that the City of Melissa may estimate the water usage for such meter and bill the account based on that estimate. I understand that
payment is due each month by the Due Date stated on my monthly bill and that a 10% late fee will be assessed on my bill if not paid by 5:30 p.m. on this same date (in addition to other remedies available to the City of Melissa). Upon installation of the
construction/hydrant meter to the fire hydrant, the RPZ backflow preventer shall be tested by a TCEQ-licensed Backflow Prevention Assembly Tester. I sign this application voluntarily as my own free act, with full knowledge of its significance, intending
for the Applicant to be legally bound thereby.
Signature*

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CONSTRUCTION/HYDRANT METER APPLICATION AND SERVICE AGREEMENT