Application for Service - Septage Hauler

Incomplete application or credit review is subject to deposit requirement.  Allow two (2) business days for processing.

 

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Date Service Requested

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 Individual or Partner Responsible for Payment

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Individual or Partner Responsible for Payment

Business Name

DBA

Email Address

 

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Owner Last Name	Owner First Name	Owner Middle Initial
Billing Mailing Address	Suite/Apartment	City
State (Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip	Business Phone Numberext.
Owner Cell Phone ext.	Owner Home Phone ext.	Fax Number ext.
Federal Tax ID Number	Business License #	Driver's License # / State

 

Name of Personal Reference	Relationship	Reference Phone#ext.	Reference Email
Reference Address	City	State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip

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COMPLETE THIS PROTION FOR ANY OTHER OWNERS / PARTNERS / OFFICERS / RESPONSIBLE FOR PAYMENT OR AUTHORIZED TO CONDUCT BUSINESS ON THIS ACCOUNT

COMPLETE THIS PROTION FOR ANY OTHER OWNERS / PARTNERS / OFFICERS / RESPONSIBLE FOR PAYMENT OR AUTHORIZED TO CONDUCT BUSINESS ON THIS ACCOUNT

Name

Email

Title

Phone #ext.

Vehicle #1

Vehicle #2

Vehicle #3

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Vehicle #1 Vehicle #2 Vehicle #3

Year	Year	Year
Make	Make	Make
Model	Model	Model
License Plate Number	License Plate Number	License Plate Number
Capacity	Capacity	Capacity

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Trailer #1

Trailer #2

Trailer #3

Trailer #1 Trailer #2 Trailer #3

Capacity	Capacity	Capacity
Vehicle Plate #	Vehicle Plate #	Vehicle Plate #
Access Card #	Access Card #	Access Card #

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If a deposit is required on your account, it shall equal the average of two (2) monthly bills.

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In case you must be contacted regarding your application, please provide a phone number at which you can be reached during normal business hours:

Daytime PHONE:ext.

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I understand I will be required to complete a truck inspection for each new vehicle / trailer utilized.

 

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Initials

AMC 26.50

I understand Anchorage Municipal Code 26.50 prohibits discharges such as the following:

Pollutant or wastewater which causes pass through or interference, i.e. sand, gravel, or cobbles

Any stormwater, surface water, surface runoff, groundwater, roof runoff, subsurface drainage, cooling water or other unpolluted water

Any water or wastewater which contains petroleum oil, non-biodegradable cutting oil, or products of mineral oil origin in amounts that will cause interference or pass through

Any solid or viscous substance, or liquid that can become viscous when cooled, in amounts capable of causing obstruction to the flow in sewers or other interference with the proper operation of the sewerage system

Any wastewater which creates a fire or explosive hazard

Any wastewater having a pH lower than 5.0 or higher than 12.5

…and agree to ensure these materials are not discharged at AWWU Septage Receiving Stations by my company or representatives of my company.

 

Initials

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PLEASE READ AND SIGN THIS AGREEMENT:

 The undersigned certifies that they are the owner-authorized representative of the business identified in this application, with lawful authority to sign for this application for utility service, and agrees to pay the applicable rates and abide by the terms and conditions as prescribed by Municipal Ordinance and Utility Tariffs for all present and future utility service.  Acceptance of this application by the Municipality of Anchorage constitutes a contract between the Municipality and the applicant.  All costs incurred by the Municipality for the collection of any unpaid accounts shall be paid by the applicant.

 The conditions under which a deposit will be required or waived are set forth in Anchorage Water & Wastewater Tariffs.

I hereby declare that the information provided is true, accurate, and complete to the best of my knowledge and belief, and is voluntarily submitted for the purpose of receiving utility service.  I understand that upon presentation, this application becomes the property of the Municipality.  I also certify that I am eighteen (18) years of age or older.

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PLEASE READ AND SIGN THIS AGREEMENT: The undersigned certifies that they are the owner-authorized representative of the business identified in this application, with lawful authority to sign for this application for utility service, and agrees to pay the applicable rates and abide by the terms and conditions as prescribed by Municipal Ordinance and Utility Tariffs for all present and future utility service. Acceptance of this application by the Municipality of Anchorage constitutes a contract between the Municipality and the applicant. All costs incurred by the Municipality for the collection of any unpaid accounts shall be paid by the applicant. The conditions under which a deposit will be required or waived are set forth in Anchorage Water & Wastewater Tariffs. I hereby declare that the information provided is true, accurate, and complete to the best of my knowledge and belief, and is voluntarily submitted for the purpose of receiving utility service. I understand that upon presentation, this application becomes the property of the Municipality. I also certify that I am eighteen (18) years of age or older.

Applicant Printed Name

Date

 

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Applicant's Signature

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 An email version of the completed form will be sent to your inbox. Please print, sign, and fax to (907) 562-0702; email to CustomerService@awwu.biz; or mail to 3000 Arctic Blvd, Anchorage, AK  99503.

Thank you.

Comments

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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