Apply for Utility Service Form Rose Valley Water 13157 E 44TH Street Yuma, AZ 85367 (623) 889-2275 info@rosevalleywater.com First Name (required) Last Name (required) Email (required) Home Phone Cell Phone (required) Mailing Address (required) City (required) State (required) Zip Code (required) Is This Property a Lease or Purchase? LeasePurchase Beginning Date of Lease (required) Length of Lease (required) Landlord/MGMT Co. Name (required) If Management Co., Contact Name Landlord/MGMT Co. Address (required) Landlord/MGMT Co. Phone (required) City of Peoria Sewer/Garbage ACCT #: (required) If Purchase, Close of Escrow Date (required) Title Co. Name (required) Title Co. Phone (required) Escrow # (required) Is this property on Septic? YesNo I agree Rose Valley Water Company requires up to 3 business days to establish service/account, once information is provided and required fees are paid. Please also note, that you must contact City of Peoria at 623-773-7160 to establish a separate account for sewer/sanitation services. Please ask the City of Peoria to provide your account number for your account with the City of Peoria, as the account number is something that is required to establish an account with Rose Valley Water Co for your water utility account. A security deposit in the amount of $100 and an establishment fee of $30 are also required prior to establishment of service/account. Once you have provided the completed New Service Request, a Rose Valley Water Company representative will call you to obtain the payment information to process the $130 (for a small fee) that is due upfront. Rose Valley Water Company’s Billing Office hours are Mon-Fri, 8am-4pm. I agree I agree that service will not be started until I have received a confirmation from Rose Valley Water Co with my start service date. Date (required) Please write your signature in the box below (required) Δ