Hydrant Meter Form – East Fork Special Utility District

Date *

Company Name *

Company Address *

Address Line 1

Address Line 2

City

State

Zip Code

Contact Name *

First

Last

Contact Phone Number *

Signature Deposit –

Contact Email *

Deposit Check Number

Deposit Amount

Refundable

Site Location

If this meter is moved to a different location, you are required to inform East Fork SUD immediately

Initial Below – Meter Reading *

A picture of the meter reading must be emailed to customerservice@eastforksud.com by the 18th of every month. In the picture, make sure the meter number on the inside of the lid and the whole face of the dial are visible.

Initial Below – Meter Condition *

All hydrant meters are sent out with a stand, handle, a lid on the dial and an RPZ and need to be returned in the same condition.

Initial Below – Meter Certification *

Every meter goes through a certification process before being issued to a customer and upon return. Any missing parts or damages found when the meter is returned will be billed accordingly. A backflow test will also be performed upon return and a $125.00 fee added to the final bill.