Service Application - Chenowith Water PUD

Prefer to print it out?

You can still download, print, and drop off or mail the paper Application for Service — or fill it out below and submit online.

📄 Download the printable PDF

Application for Service

Good communications is a key to a good relationship between a public service and the patrons it serves. Fields marked * are required.

First Name *

Last Name *

Middle Initial

Today’s Date

Date Effective * (date you want service to start)

Spouse or Co-Applicant

Service Address *

Mailing Address (if different from service address)

Telephone *

Second Telephone (optional — e.g. co-applicant)

Email Address *

Do you own or rent? *

Own Rent

If renting: landlord’s name, phone & address (optional, but helpful)

Applicant’s Employer

Co-Applicant’s Employer

Stipulations & Agreements

The applicant(s) hereby agrees to the following conditions and/or stipulations:

To be responsible for the prompt payment for all charges for service as billed from the date service is started by the PUD on the basis of this application.
To give proper notification in advance of terminating service.
To be responsible for payment for all services at this location until such time as proper advance notice of service termination has been received by the PUD.
To abide by all customer policies of the PUD.
To pay a new account processing charge of $35.00 (non-refundable).
That the applicant's credit history and ratings shall only be available to the customer; any person, firm or corporation authorized by the customer; and any bonafide credit reporting agency.
In the event the account name is a corporation, the person(s) signing this agreement personally guarantees payments for all charges for water used during the period of service.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to discontinue water service immediately.
I understand that the City of The Dalles will be provided non-confidential information regarding water service to the above-listed address.
To owner of property and others: Pursuant to district policies water service will not be restored to this property without payment in full of all delinquent sums owing on this account. The owner, prospective occupiers and purchasers should contact the district manager for information regarding this account.

I have read and agree to all of the Stipulations & Agreements above, including the $35.00 non-refundable new-account processing charge. Typing my name below serves as my electronic signature. *

Electronic Signature (type your full legal name) *

Co-Applicant Signature (type full name)

Your information is emailed directly to the Chenowith Water PUD office.