Snowbird Application

2. Today's Date:*
   Today's Date:
4. Name:*
6. Service Address:*
8. Please provide the date range for which you will be leaving your residence and would like the water turned off. And the date for which you will return on or about to your residence.*
   Please provide the date range for which you will be leaving your residence and would like the water turned off. And the date for which you will return on or about to your residence. Start Date

   —

   Please provide the date range for which you will be leaving your residence and would like the water turned off. And the date for which you will return on or about to your residence. End Date

10. - I understand that I must be gone for a minimum of two (2) consecutive months in order to temporarily cease billing.

12. - I understand that I must contact the Utility Billing Office at least one (1) business day in advance to have services re-connected.
14. - If I should return to the service address within the dates listed above, I realize that I may be billed for usage, or charged for additional turn on/off trips.
16. - In certain circumstances, the City of Fairfield may not be able to turn water service off at the street valve. I understand that it is my responsibility to turn water service off at the main valve inside the home in order to prevent water leaks and water damage. The City of Fairfield shall not be responsible for compensatory damages due to water leakage in the home during my absence.
18. By clicking "I agree" you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.
20. Do you agree?*

    1. Yes, I agree
22. 
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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