City of Santa Cruz : Online Forms

Survey/Form Review

SCMU Application - Outside City Residential Irrigation

SANTA CRUZ MUNICIPAL UTILITIES (SCMU)

OUTSIDE CITY RESIDENTIAL ACCOUNTS

IRRIGATION SERVICE SIGN-UP

1. SERVICE LOCATION INFORMATION

Service Address - Street, Apt/Ste:*

Service Address - City, State, Zip Code:*

Number of people living at the service address:*

Requested Service Start Date (No weekends or holidays):*

2. APPLICANT INFORMATION

Last Name, First Name:*

Billing Address - Street, Apt/Ste:*

Billing Address - City, State, Zip Code:*

Primary Phone Number:*

Alternate Phone Number:

E-mail Address:

Identification - Document Type:*

Document Number (ID):*

Issued By (State or Country):*

Previous Service Address with SCMU

I DECLARE UNDER PENALTY OF PURJURY THAT 1) I AM THE RESPONSIBLE PARTY AT THE SERVICE ADDRESS AND/OR AN AUTHORIZED REPRESENTATIVE OF THE BUSINESS, AND 2) THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.

3. OFFICE USE ONLY

Account # --- Meter # --- Location

Deposit Receipt # --- Field Remarks