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Fees & Deposits
Customer Service Agreement Form
You will need information from the
Fees & Deposits
page to fill out the 'Service Deposit' section of the Customer Service form.
I/we (if married, both names must be provided)
(hereinafter, the “CUSTOMER”), desire to be a CUSTOMER of the Jefferson Water and Sewer District (hereinafter, the “DISTRICT”) and directly receive the bills for utility service charges for the following service address:
under this Customer Service Agreement (hereinafter, “CSA”).
If yes, name of Tenant:
For good and valuable consideration, including the right to obtain or continue to receive services from the DISTRICT, the CUSTOMER agrees to the following:
1. LIABILITY FOR PAYMENT: CUSTOMER agrees to pay the DISTRICT for utility service charges, and any other applicable DISTRICT fees and/or penalties, for the above service address during their tenancy at such address. CUSTOMER is responsible for all applicable tap fees, usage charges, deposits and any other applicable District fees or charges for the above listed property. If any such fees or charges are unpaid, the District may, at its sole discretion, terminate District services to the property and certify delinquent charges to the County Auditor, resulting in a lien upon the property. The District may also impose penalties or pursue any other remedy permitted by law. While the District may, in its sole discretion, as a courtesy, and at the request of the Owner, directly bill a tenant of said property for usage charges, the owner shall ultimately be responsible for any uncollected District fees or charges and if such delinquent fees or charges remain unpaid, may be certified to the County Auditor, resulting in a lien upon the property.
2. BILLING: The rates and charges are prepared and billed monthly in accordance with DISTRICT Regulations. Bills and notices relating to the conduct of the business of the DISTRICT will be mailed to the CUSTOMER at the service address indicated above (or mailing address, if provided below) unless the District is informed of a new mailing address by submission of a new CSA, or unless a DISTRICT change of address form has been completed and returned in a timely manner to the DISTRICT business office. The DISTRICT shall not otherwise be responsible for delivery of any bill or notice.
3. SERVICE DEPOSIT: In accordance with District regulations is required for a new CUSTOMER account, or for an existing CUSTOMER account where such CUSTOMER has filed for bankruptcy, been disconnected from the District system or had delinquent District charges certified to the County Auditor for collection since establishing an account. Service deposit amounts are as follows: Water and Sewer Service - Deposit: $132.96 Water Service Only - Deposit: $50.92 Sewer Only (unmetered) - Deposit $128.22
Service Deposit: :: Refer to 'Fees & Deposits' Page
Your information will be submitted securely to our Customer Service Administration and kept on file. To complete the agreement process, we will require your signature, a copy of a valid driver’s license or state ID along with your deposit. [Deposit amounts will vary depending on the services rendered. Please refer to ‘Fees & Deposit’ selection to determine the deposit amount or contact our office for assistance].
NOTE: If there is a Tenant Service Agreement for the service address indicated above, the service deposit will be collected from the Tenant.
4. INSPECTION BY DISTRICT: CUSTOMER agrees to be subject to inspection of DISTRICT property at the service address listed above in accordance with DISTRICT Regulations.
5. ACCOUNT CHANGE: Customer agrees to provide District with reasonable notice (typically 2 weeks) prior to moving from the above address or in the event the account for the above address will begin in the name of another party.
6. RULES AND REGULATIONS: CUSTOMER further agrees to adhere to all District rules and regulations, and agree, in particular, to be liable for all water and sewer fees and charges for the above listed premises, whether the accounts for such premises are carried in my name or in the name of tenants or other persons.
By completeing the form below, CUSTOMER understands and agrees to all of the foregoing.
Customer's Spouse Name:
District of Columbia
Northern Marianas Islands
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Your information will be submitted securely to our Customer Service Administration and kept on file. To complete the agreement process, we will require your signature, a copy of a valid driver’s license or state ID along with your deposit. [Deposit amounts will vary depending on the services rendered. Please refer to ‘Fees & Deposit’ Part III located on Page 7 to determine the deposit amount or contact our office for assistance].
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