Request for Service – Provo Water Company

Name *

First

Last

Account Number *

Phone *

Email *

Service Address *

Address Line 1

Address Line 2

City

State / Province / Region

Multiple Choice

Rushed Service – $100: Same day reconnection after 2.00 PM following non payment, charged in addition to the 25 dollar reconnection fee
Rushed Service – $100: Same day activation for payments received after 2.00 PM, instead of the standard 48 hour timeline.
Service Call – $25: On-site visit in response to a customer report or service request where the issue is not related to PWCo equipment or service.
Meter Verification – $75.00 per hour: On-site visit at the customer’s request to identify, label, trace, or confirm meter connections.

What date and time are you requesting service? *

Date

Time

Terms and Conditions

By submitting this request, the customer agrees to the following:

Please tick ALL BOXES. *

I acknowledge that the applicable service fee will be charged to my account.
I understand that all fees are non-refundable once dispatched.
I understand that service timelines may vary due to operational demands.
I agree to provide safe and unobstructed access for PWCo staff.
I acknowledge that PWCo may decline service if safety or access issues exist.

Signature *

Clear Signature

I confirm that I have read and understood the Terms & Conditions outlined above. I agree to provide accurate information and comply with all requirements for requested service.

Date / Time *

Date

Time

Monday	9:00 AM — 4:00 PM
Tuesday	9:00 AM — 4:00 PM
Wednesday	9:00 AM — 4:00 PM
Thursday	9:00 AM — 4:00 PM
Friday	9:00 AM — 4:00 PM
Saturday	Closed
Sunday	Closed