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Customer Name (required) Cell Phone (required) Home/Office Phone Email Address (required) Suncadia Property Address where Service is provided (required) City (required) State (required) WashingtonAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWest VirginiaWisconsinWyoming Postal Code/Zip (required) Property Location: Phase Division Lot # Billing/ Mailing Address (required) City (required) State (required) WashingtonAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWest VirginiaWisconsinWyoming Postal Code/Zip (required) By signing below, the customer asserts that all information is true and accurate to the best of their knowledge. Furthermore, the customer is serving notice that the customer desires water service from SWC and agrees to comply with the SWC’s Regulations and Guidelines and the Rules and Regulations on file with the WUTC and in effect at the time service is furnished. Customer also asserts that if they are signing for a Limited Liability Corpora- tion they agree to be held personally responsible and liable for all aspects of the account, including payment for any and all charges. Date (required) Signature (required)

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