Release for Reconnection of Water

2. Water Service Information
   I request the reconnection of water at the following address from the City of Rio Rancho (this is NOT a HUD, foreclosure, Repossessed Home, or Short Sale):

   I request the reconnection of water at the following address from the City of Rio Rancho (this is NOT a HUD, foreclosure, Repossessed Home, or Short Sale):

4. Service Address:*

   Address, City, State, Zip

5. Requested Turn on Date:*
   Requested Turn on Date:

6. For*

   1. Non - Payment
   2. New Service

10. Applicant Information

12. Name:*

    Must be the accountholder

13. Phone:

17. 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.

    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.

21. Acknowledgement and Signature
    I release the City of Rio Rancho Water Department of any liability in connection with turning on water service to the above referenced property. Since no one will be present when the water is turned on, I will take full responsibility for any leaks or running faucets that may result in water damage, to the above mentioned property. I confirm that this service address is NOT a HUD, Foreclosure, Repossessed Home, or Short Sale.

    I release the City of Rio Rancho Water Department of any liability in connection with turning on water service to the above referenced property. Since no one will be present when the water is turned on, I will take full responsibility for any leaks or running faucets that may result in water damage, to the above mentioned property. I confirm that this service address is NOT a HUD, Foreclosure, Repossessed Home, or Short Sale.

23. Signature *

24. Date*
    Date

Leave This Blank:


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