If you’d prefer to download this form and email it to us directly, you can download the file by clicking here. CONTRACT FOR SERVICE The undersigned hereby makes application to the BOARD OF TRUSTEES OF THE KEOKUK MUNICIPAL WATERWORKS for service on the premises described below. Applicant agrees to pay for such service as bills are rendered, at the rates, and according to the Rules and Regulations established or to be hereafter established by the Board, and to observe said rules in the use of such service at all times. Every person or consumer must sign a written application and make a deposit of such amount as is determined by the Board before a meter is installed or used. The deposit will be returned upon discontinuance of service, provided all bills have been paid. It is understood and agreed that the Board shall not be liable or held responsible by the reason of the breaking of any service pipe or apparatus, water coil, or failure in the supply of water due to accidents, break-downs or other causes. Applicant warrants that the services applied for are to be used by said applicant only, and a breach of this warranty will authorize the Board to discontinue such service without notice. CHANGING LOCATION OF METERS 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.Street Address *Apartment, suite, etcBilling AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeEmail Address *E-Bill *YesNoDate of Possession *RentingBuyingOwner *Owner's Phone *Automatic Withdrawal (If no, please call 319-524-5285) *YesNoCustomer Identification InformationName of Lessee and Occupants over 18 *Date of Birth *Phone *Employer *Social Security Number *0 / 9Name of LesseeDate of BirthPhoneEmployerSocial Security Number0 / 9Signature *Start signing your signature hereYour browser does not support e-Signature field.Payment must be mailed to Keokuk Water Works, P.O. Box 10, Keokuk, IA 52632. Additionally, please contact our office to schedule an appointment for service. (319) 524-5285 *** ID IS REQUIRED, PLEASE ATTACH A COPY OF YOUR ID *** *Choose FileNo file chosenDelete uploaded fileUPON SUBMISSION, YOU WILL BE REDIRECTED TO THE AUTOMATIC WITHDRAWAL PAGE TO FILL OUT YOUR BANKING INFORMATIONSubmitPlease do not fill in this field.
