Forms
Email form to: billing@bentoncountywater.com or
Benton County Water District #1
Public Water Authority of the State of Arkansas
P.O. Box 127 • 111 East Rose St • Avoca, AR 72711 • Phone: 479-636-0002 • Fax: 479-636-7676 • email billing@bentoncountywater.com or books@bentoncountywater.com
Water User Agreement
RENTERS & HOMEOWNERS ONLY
Account No. _____________________________
(for Office Use Only)
Date___________________________________
OCCUPANT INFORMATION
Service Address
___________________________________
___________________________________
___________________________________
Mailing Address if Different:
___________________________________
___________________________________
___________________________________
Occupant #1
Name: ___________________________________________________
Email Address: ___________________________________________________
Phone No: ___________________________________________________
Alternate Phone No: ___________________________________________________
Social Security No: ___________________________________________________
Place of Employment: ___________________________________________________
Occupant #2
Name: _______________________________
Phone No: _______________________________
Alternate Phone No: _______________________________
Social Security No: _______________________________
Place of Employment: _______________________________
Email Address:_______________________________________
Account No. _____________________________
(For Office Use Only)
Date_____________________________
I, ____________________________________, hereby make application to the Benton County Water District No. 1, PWA (hereinafter called BCWD #1) for water service.
I agree:
1. To abide by all federal, state, county, local, and BCWD #1 laws, codes, rules, resolutions, and policies affecting my water service, which may be modified from time to time.
2. To maintain in good working order the water service line from the meter to my house(s), building(s), outlets, or faucets, and all plumbing in my house(s) or building(s).
3. Once water passes through the meter, it is my responsibility to pay for the water.
4. Bills will be sent out on, or before the 1st day of each month. All bills will be due by the close of business on the 10th day of each month. If the 10th falls on a weekend or holiday, the bill will be due the following business day, by the close of business. Bills not paid by due date; will be considered past due and a late penalty shall be applied. If the gross bill is not paid by the close of business on the 20th day of each month, unless the 20th falls on a holiday or weekend, then the close of the next business day, water service shall be disconnected and a lock meter charge fee shall be applied. Failure of the District to submit a bill shall not excuse the member from their obligation to pay charges assessed. Duplicate billings shall not be furnished by the Authority. Failure to receive a bill shall not exempt any customer from accruing a penalty for late payment. The presentation of a bill to the customer is only a matter of accommodation and not a waiver of this rule.
5. I also understand that for my service to be resumed, full payment of my bill must be made during normal office hours of 8 a.m. to
4 p.m. If reconnection is necessary during non-business hours an additional service charge will be required.
METER DEPOSITS
HOMEOWNER $100.00_________
RENTER $150.00_________
1” METER $250.00_________
2” METER $500.00_________
3” METER $1000.00_________
ACTIVATION FEE $20.00________
DATE OF ACTIVATION:__________________________
Signature_____________________________
***PLEASE INCLUDE A PICTURE OF YOUR DRIVER'S LICENSE FOR ACCEPTANCE