Step 1 of 9 11% By acceptance of service, the Owner (and Tenant if applicable) understands that he/she must comply with all policies of Hardin County Water District No. 2 (“District”), and all other local, state, and federal laws. Please note the following: If the application is signed by an authorized agent, the account will remain in the name of the Owner. The Owner/Tenant/Occupant/ may be held liable for damaged/stolen meters up to and including civil/criminal penalties, fees, & costs. A copy of the settlement statement and/or warranty deed (Owner) or a copy of the notarized lease agreement (Tenant) and a current state identification, US Passport, or Military ID is required to establish an account. There is a non-refundable new account service fee of twenty five dollars ($25) and a sixty dollar ($60) deposit for new accounts. Debit, credit or cash will be accepted for payment deposits. A payment authorization for debit and credit payments is attached. Cash payments may be made in our office only. Deposits must be paid in full at the time of application and will be refunded at the close of the account or after two years satisfactory payment history with interest (whichever occurs first). The District may terminate water services if payment in full is not received by 10 days past the due date on the bill. If your bill is paid after the due date, a 10% late penalty will be added to the balance due. Failure to receive a bill does not excuse the responsibility to pay. If service is interrupted, a fifty dollar ($50) reconnection fee will be added to the account balance for reconnections during the business day. Reconnections after 4:30pm will be assessed an additional fifteen dollar ($15) after-hours fee. The delinquent balance including any fees must be paid in full before service will be restored. The District does require proof of identity of each applicant and occupancy information sufficient to establish the identity of the Owner and the person authorized by the Owner to consume water service at the service address. The Federal Trade Commission requires water utilities to comply with the Federal Identity Theft Red Flag Rule. The District will verify an applicant’s social security number when a new account is established or transferred. In consideration for having water service initiated/restored at the above address, the Owner agrees to ensure that all water service facilities (sinks, tubs, faucets/inside and outside, etc.) are turned off. The Owner understands that the District is not responsible for water damage to the property or its contents. (Please note: If new service is being established and the water is off, it may take up to 2 business days from processing of the completed application along with the required documentation. Start Service On: (Two (2) business days after application date)* Date Format: MM slash DD slash YYYY Primary ApplicantName* First Last SSN/Tax I.D.*DOB* Date Format: MM slash DD slash YYYY License/ID#*Home PhoneCell Phone*Email* Additional ApplicantName First Last SSN/Tax I.D.DOB Date Format: MM slash DD slash YYYY License/ID#Home PhoneCell PhoneEmail Service InfoService Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this also your mailing address?*YesNoMailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Property InformationDo you own or rent this property?*OwnRentLease, Deed or other Proof Of Residency Required (Handwritten leases are not acceptable proof of residency.) Note** Deeds can be found on the Hardin County Clerk's Website at www.hccoky.org.* Drop files here or Accepted file types: jpg, pdf, doc, docx, png, bmp, tiff, xls. Residential or Commercial*ResidentialCommercial Account HistoryHave you ever had service with Hardin County Water District No. 2*YesNoIf Yes, Please list the address Street Address Address Line 2 City Would you like to disconnect those services?*YesNoN/AIf yes, on what date: Date Format: MM slash DD slash YYYY Primary Applicant Signature*Additional Applicant Signature LegalThis agreement entered into between the user, whose address is stated above, hereinafter called “USER” and Hardin County Water District #2, 360 Ring Road, Elizabethtown, KY, hereinafter called “SUPPLIER”. Whereas, the USER desires to purchase water from the SUPPLIER, the USER hereby enters into this water user agreement as required by the Bylaws of the SUPPLIER. Now therefore, in consideration of the mutual covenants, promises, and agreements herein contained, it is hereby understood and agreed by the parties hereto as follows: The SUPPLIER shall furnish, subject to the limitations set out in Rules and Regulations as filed with the Public Service Commission, that are now in force or as hereafter amended, such quantity of water as the USER may desire in connection with the property to be served by this agreement. The USER shall install and maintain at their own expense a service line which shall begin at the meter and extend to the dwelling or place of use. The SUPPLIER shall have exclusive rights to use such cutoff valve and water meter. The USER shall connect their service lines to the water distribution system and shall commence to use water from the system on the date the water is available to them. THE SUPPLIER, REGARDLESS OF WHETHER THE USER IS CONNECTED TO THE SYSTEM, MAKES WATER CHARGES TO THE USER WILL COMMENCE ON THE DATE SERVICE AVAILABLE. Construction of water lines to serve the property covered under this agreement depends upon the feasibility, availability of funds for construction and approval of all local, state, and federal agencies having jurisdiction over this type of facility. THE SUPPLIER DOES NOT GUARANTEE WATER SERVICE WILL BE MADE AVAILABLE TO THE USER. The user agrees to comply with and be bound by the Rules and Regulations of the SUPPLIER, now in force or as hereafter duly and legally supplemented, amended, or changed. The USER agrees to pay for water at such rates, time and place as shall be determined by the SUPPLIER, and agrees to the imposition of such penalties for noncompliance as are now set out in the SUPPLIER’S Rules and Regulations, or which have been or hereafter be adopted and imposed by the SUPPLIER. The SUPPLIER shall determine the allocation of water to the USER in the event of a water shortage, and may shut off water to the USER if they allow a connection or extension to be made of their service line for the purpose of supplying water to another party. In the event the total water supply shall be insufficient to meet all the needs of the user, or in the event there is a shortage of water, the SUPPLIER may pro-rate the water available among the various user, on such basis as is deemed equitable by the GOVERNING BODY, and if at any time the total water supply shall be insufficient to meet all the needs of the users, the SUPPLIER must first satisfy all of the needs of all users for domestic purposes before supplying any water for livestock purposes and must satisfy all the needs of all users for both domestic and livestock purposes before supplying any water for garden purposes. The USER agrees that no present or future source of water will be connected to any water lines served by the SUPPLIER’S water lines and will disconnect from their present water supply prior to connecting to and switching to the SUPPLIER’S system and shall eliminate present or future cross-contamination in their system. The failure of the USER to pay water charges duly imposed shall result in the automatic imposition of the following penalties: Nonpayment after the due date of the original bill will result in a penalty of 10% percent of the delinquent account. Nonpayment within twenty days from the mailing date of the original bill will result in termination of service. In the event it becomes necessary for the SUPPLIER to terminate service a termination charge of $25.00 plus a reconnect charge of $25.00 as set forth in the utility’s tariff will be assessed if service has been terminated for non-payment. It is understood and agreed that the supplier reserves the right to determine the size of service connection to be used to supply water to the USER. A 5/8” X ¾” meter will be used unless the USER contracts for a larger meter. A separate meter must be installed for each residence, mobile home or other. The USER agrees to grant to the SUPPLIER, it’s successors and assigns a perpetual easement in, over, under, and upon land owned by the USER, with the right to erect, construct, install, and lay, and thereafter use, operate, inspect, repair, maintain, replace, and remove water pipeline and appurtenant facilities, together and remove water pipelines and appurtenant facilities, together with the right to utilize adjoining lands belonging to the USER for the purpose of ingress to and egress from the said lands.* I acknowledge that I have read and understand that the $25 connection fee will be on my first bill * I acknowledge that my application will not be processed until the District has received this application, along with a copy of my ID, deed or lease, and deposit. Signature Customer DepositYOUR SIGNATURE ON THIS PAYMENT AUTHORIZATION FORM DENOTES ACCEPTANCE OF ALL TERMS & CONDITIONS INCLUDED ON THIS FORM AND THIS WATER USER AGREEMENT AND ACCOUNT APPLICATION. *Please Note - Returned payments are subject to a $25.00 fee. Returned payment of a deposit will result in termination of service without further notice until such deposit is paid in full. Credit Card -For your convenience, Hardin County Water District No. 2 will use this authorization to charge your credit or debit card account for your customer deposit. There is a $2.50 processing fee for credit/debit card transactions. All other payments may be made in our office at 360 Ring Road in Elizabethtown.Customer Deposit Total: $60.00Processing Fee: $2.50 Payment Total: $62.50Card TypeAMEXVISAMasterCardDiscoverCard Number*Expiration Date*Security Code*Visa/MasterCard/Discover (3 Digits), Amex (4 Digits)Deposit* I understand that my application for new service will not be processed without receipt of deposit Cardholder Printed NameCardholder Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code *** The cardholder named above hereby authorizes Hardin County Water District No. 2 to charge my credit or debit card for the total payment amount above. Primary Applicant Signature*Secondary Applicant SignaturePAYMENT POLICY: -Hardin County Water District No. 2 requires payment of deposit in full, at the time services are requested. All services will be denied without complete payment. NO DEPOSITS WILL BE BILLED AND MUST BE PAID IN ADVANCE. TAX EXEMPT STATUS: -If you are exempt from paying sales tax, you must forward a certificate of exemption prior to the time of payment. VerificationPhoto ID* I understand that my application will not be processed without a photo ID. (Residential Accounts) Primary Applicant Photo ID*Accepted file types: jpg, pdf, doc, docx, png, bmp, tiff, xls.Additional Applicant Photo IDAccepted file types: jpg, pdf, doc, docx, png, bmp, tiff, xls.It is the responsibility of the applicant to submit necessary documentation. Until these necessary items are received in our office, applications will not be processed.CommentsThis field is for validation purposes and should be left unchanged.