CONTRACT FOR SERVICE

The Keokuk Municipal Waterworks requires this form to be completed, and, if renting or purchasing on contract, a utility deposit must be paid before service is connected unless you have signed up for our direct payment plan. A $10.70 Service fee will be added to your first water bill every time new service is started. Identification required for each adult occupant.

I/We hereby apply for utility services for the premises listed above pursuant to the rules of Keokuk Municipal Waterworks. I/We acknowledge that all statements given above are true and accurate to the best of my/our knowledge. I/We agree to pay for all bills for utility services provided to me/us by the Keokuk Municipal Waterworks. If I/we fail to pay bills in a timely manner, I/we understand that the services may be discontinued. I/We agree to give prior notice to the Keokuk Municipal Waterworks of my/our intent to discontinue utility services and agree to pay the final bill promptly and in full. I/We also understand that should I/we neglect to make final payment, any deposit made with this application will be retained by the Keokuk Municipal Waterworks and applied to my/our final bill or refunded if the final bill is paid in full. I/We further understand that any delinquent accounts must be paid in full before I/we will be allowed utility service at a new Keokuk Municipal Waterworks address. I/We understand that the Keokuk Municipal Waterworks may submit any delinquent accounts to the Iowa Department of Revenue for collection. Water bills are due no later than the 5th of each month. If selected, I/We hereby authorize the Keokuk Municipal Waterworks to initiate electronic water/sewer/garbage bills via email for the account listed above. I/We acknowledge that it is my/our responsibility to notify the Keokuk Municipal Waterworks of any changes of the e-mail address listed above. Failure to receive a bill or update an e-mail address does not relieve me/us of the responsibility of making payments as they are due. I/we understand that by approving electronic billing, I/we will no longer receive a paper bill in the mail unless I choose both paper and email. The parties acknowledge and agree that this Application may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

The location of any water meter shall in no case be changed without permission being obtained from the Waterworks manager, and in no case shall water be used without a meter. The meter must be accessible to Waterworks service personnel at all times. No meter is to be located where there is a likelihood of the meter being damaged by freezing. All piping must be arranged so that the meter will be in a horizontal position when set. Any meter problems should be reported to the Waterworks. The Keokuk Municipal Waterworks may seek legal action against any person who has violated any of the rules and regulations.

Upon submission of this form, you will be redirected to the Direct Payment Plan page to sign up.