Name on Account (required)

Mailing Address (required)

Home Phone

Cell Phone (required)

Start Date of Service (required)

Email (required)

Property Address (required)

If renting or leasing please list property owner

I hereby agree that I comply with the Rules & Regulations of Falls Water Company which have been submitted to the Idaho Public Utility Commission of Boise, ID. A copy is available from our office for your inspection. I agree to pay the (periodic) charges as billed to me from the invoices rendered by said company.

Date (required)

Please write your signature in the box below (required)