Name on Account (required)

Spouse or Legal Guardian

Mailing Address (required)

Mailing Address City (required)

Mailing Address State (required)

Mailing Address Zip Code (required)

Home Phone

Cell Phone (required)

Start Date of Service (day of the title change or the first day of lease) (required)

Email (required)

Property Address (please add actual physical location for service, no PO's. If a vacant lot enter Tax Lot number) (required)

Property Address City (required)

Property Address State (required)

Property Address Zip Code (required)

If renting or leasing please list property owner

If you want to add anyone as a contact to your account please provide their name, phone number, and relationship

Paperless Billing?
YesNo

Would you like to be contacted to set up automatic billing?
YesNo

I hereby agree that I comply with the Rules & Regulations of the Salmon Valley Water Company which have been submitted to the Oregon Public Utility Commission of Salem, OR. 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.
Today's Date (required)

Please write your signature in the box below (required)