5034 W Avenue L • Quartz Hill, CA 93536

Phone Number: 661-943-3170

Fax: 661-943-0457

www.qhwd.org

When a change in property ownership occurs, the water service is temporary and subject to shutoff without further notice pending satisfaction of District requirements.  The water service can only become permanent upon satisfaction of District requirements, including payment of outstanding bills, completion and signing of this form, and presentation of verifiable proof of ownership as specified to you verbally. (Policies, Procedures, Rules and Regulations 7:02.A2)  Quartz Hill Water District is not responsible for nor does it guarantee the quality of water to be delivered to its customers.

This Application for Water Service is to be completed and signed by the owner of the property.   In the event that a properly signed form is not on file with the District, the water service will be  subject to discontinuance without further notice. A copy of the bill will always be sent to the location receiving water service (per Policy after SB998). The owner may request that another bill be sent elsewhere.   The purpose of this form is to provide the District with the correct billing information   and to notify the property owner that they are ultimately responsible for the water bill for the property to the extent permitted by law.