Name on Account (required)
Mailing Address (required)
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Zip (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 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. Date (required) Please write your signature in the box below (required)