Application for Metered Water Service

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Property Information

Name of property owner required

Property address required

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Owner Information

Mailing address required

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Service Information

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If Yes, please complete the following:

Name of property owner required

Mailing address required

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The undersigned, being the owner/tenant associated with the property listed above, hereby requests that the Clifton Park Water Authority supply water to the premises at said location and agrees to comply with all regulations of the CPWA, including those listed in the CPWA’s General Terms and Conditions of Service.  The undersigned further understands that they are responsible for all charges for water service to this property until notice to discontinue service is given and a final meter reading is obtained.

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