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2. Water Service Information
   I request the reconnection of water at the following address from the City of Rio Rancho (this is a HUD, Foreclosure, Repossessed Home, or Short Sale Property)
4. Service Address:*
   Address, City, State, Zip
5. Requested Turn on Date *
   Requested Turn on Date
6. For:*

   1. Non - Payment
   2. New Service
8. I will be present or have a responsible party present during the time of:*

   1. 8:00 A.M - 12:00 P.M
   2. 1:00 P.M - 5:00 P.M
12. Applicant Information
14. Name:*
15. Phone:
19. Ordinances
    Section 51.09 - Discontinuance, denying, and restoration of service: The utility reserves the right to schedule restoration of utility service on the day following payment of balance due.
23. Acknowledgement and Signature
    I understand that if there is no one present during the time that I have requested the reconnection to be completed, I will have to call the office to re-schedule the reconnect. This may delay the reconnection to be completed on the next business day.
25. Signature:*
26. Date:*
    Date:
Leave This Blank:


28. Submit Submit and Print

* indicates a required field