APPLICATION FOR WATER SERVICE 2. Attach your …

1 PO Box 350, Chino Valley, Arizona 86323 / Phone: (928) 717-2619 / Fax: (928) 636-0684 / APPLICATION FOR WATER SERVICE 1. Please complete and sign the last (3) pages of this packet. Keep the remaining pages for your records. 2. Attach your check or money order to the APPLICATION {see the first page of the APPLICATION for the amount of deposit(s)}. Please deliver the APPLICATION /deposit to one of the locations shown below. Your APPLICATION will be processed within 24 to 48 hours. 3. If the WATER SERVICE is currently off, you will need to call our office to set up an appointment to have the WATER turned on. Someone must be at the premise at the time the WATER is turned on. Please call 928-717-2619 for an appointment. Thank you Applications/Deposits By Mail: PO Box 350, Chino Valley, AZ 86323-0350 Or Office: 501 North Highway 89, Chino Valley, AZ 86323 (Rear Building) Hours: M-F 8:30am to 4:30pm PO Box 350, Chino Valley, Arizona 86323 / Phone: (928) 717-2619 / Fax: (928) 636-0684 / TARIFF SCHEDULE UTILITY: GRANITE MOUNTAIN WATER CO.

2 INC. DECISION NO: 75814 DOCKET NO: W-02467A-14-0230 et al. EFFECTIVE: December 1, 2016 RATES AND charges MONTHLY USAGE CHARGE SERVICE LINE AND METERS INSTALLATION (Refundable Pursuant to R14-2-405) METER CHARGE GALLONS METER LINE CHARGE METER CHARGE* TOTAL 5/8 x 3/4 $ N/A 5/8 x 3/4 $ $ $ 3/4 $ N/A 3/4 $ $ $ 1 $ N/A 1 $ $ $1, 1-1/2 $ N/A 1-1/2 $ $ $1, 2 $ N/A 2 $1, $1, $2, 3 $ N/A 3 $1, $2, $3, 4 $ N/A 4 $1, $3, $5, 6 $1, N/A 6 $2, $6, $8, Over 6 Actual Cost Actual Cost Actual Cost *Note: Meter charge includes meter box or vault. COMMODITY RATES (PER 1,000 GALLONS OF USAGE) 5/8 x 3/4" Meter & 3/4" Meter (All Classes) 0 to 3,000 gallons $ 3,001 to 10,000 gallons $ All gallons in excess of 10,000 $ 1 Meter (All Classes) 0 to 15,000 gallons $ Over 15,000 gallons $ 1 1/2 Meter (All Classes) 0 to 30,000 gallons $ Over 30,000 gallons $ 2 Meter (All Classes) 0 to 50,000 gallons $ Over 50,000 gallons $ 3 Meter (All Classes) 0 to 100,000 gallons $ Over 100,000 gallons $ 4 Meter (All Classes) 0 to 150,000 gallons $ Over 150,000 gallons $ 6 Meter (All Classes) 0 to 300,000 gallons $ Over 300,000 gallons $ Hydrant WATER & Standpipe WATER (Not Individually Assigned) All Usage, per 1,000 Gallons $ SERVICE charges Establishment $ After Hours Charge (At Customer Request)(Flat Rate) $ Reconnection (Delinquent) $ Meter Test (If Correct) $ Deposit * Deposit Interest (Per Year)

3 * Re-Establishment (Within 12 Months) ** NSF Check $ Deferred Payment (Per Month) Meter Re-Read (If Correct) $ Late Payment Penalty (Per Month) ** Moving Customer Meter at Customer Request At Cost * Per Commission rule R14-2-403(B). ** Months off system times Monthly Usage Charge, per R14-2-403(D). ** percent of the unpaid balance per month KEEP FOR YOUR RECORDS PO Box 350, Chino Valley, Arizona 86323 / Phone: (928) 717-2619 / Fax: (928) 636-0684 / New WATER SERVICE Connection All new WATER connections applied for within Granite Mountain WATER Company area will be installed only after mobile home or house is installed or constructed and WATER lines have been inspected by our installers. This must be done prior to backfilling trench. Minimum trench depth may not be less than thirty (30) inches from ground level.

4 A back-flow device (Check Valve) approved by state and/or other regulatory agency must be placed in the SERVICE line where it leaves the meter to the house or mobile home and must be visible to inspectors. A Gate Valve must be installed in the line approximately twelve (12) inches from the meter, if either of these items is missing, SERVICE will be denied until requirement is met and device is installed. This requirement has been in effect since 1985 and will remain in effect unless ordered changed by state or federal law. Customer is responsible for installation of all lines and devices from WATER meter to home. KEEP FOR YOUR RECORDS PO Box 350, Chino Valley, Arizona 86323 / Phone: (928) 717-2619 / Fax: (928) 636-0684 / APPLICATION FOR WATER SERVICE Office Use Only Account Number: _____ Premise Number: _____ Read Date: _____ Beginning Reading: _____ Date SERVICE Requested: _____ Customer Name(s): _____ Existing SERVICE Line New SERVICE Line (5/8 Meter) New SERVICE Line (1 Meter) SERVICE Line $ $ Meter Charge $ $ Security Deposit $ $ $ Establishment Fee $ $ $ Sales Tax $ $ $ Total $ $ $ Advance to Construction ( ): Each advance in aid of construction for a SERVICE line or meter shall be repaid by the utility by an annual credit of one-tenth of the amount received.

5 Said credit to be applied upon the WATER bill in November of each year until fully paid, and said credit to commence the month of November for all such advances received during the preceding calendar year. ATC shall stay with the home and balance is not refundable upon sale of the home. Security Deposit: The deposit may not exceed two (2) times the average residential class bill of the company for residences. The company may review all deposits after SERVICE has been connected and adjust the deposit amount based on the customer s actual usage. Deposits shall earn interest at the rate of 6% per annum. Said interest shall be credited to the customer s bill annually. Residential security deposits shall be refunded after twelve (12) months of SERVICE with NO DELINQUENCY. The company may re-establish the deposit if the customer is delinquent three or more times within a twelve-month period.

6 Any deposit still on file when SERVICE is disconnected will be first credited to any unpaid amounts and any amount due will be mailed within 30 days after date final bill to customer s last known address. Bills which are not fully covered by the deposit will be billed to customer. Establishment Fee: As specified in the utility s tariffs cover the cost of establishing a new account and the associated sales tax are non-refundable. BILLS ARE DUE AND PAYABLE ON THE 15TH DAY OF THE MONTH FOLLOWING. ANY AMOUNT NOT RECEIVED WITHIN 15 DAYS WILL BE CONSIDERED DELINQUENT AND SUBJECT TO THE UTILITY S TERMINATION PROCEDURE. I have read and fully understand the information above: Applicant Signature: Date: Co-Applicant Signature: Date: Page 1 of 3 PO Box 350, Chino Valley, Arizona 86323 / Phone: (928) 717-2619 / Fax: (928) 636-0684 / APPLICATION FOR WATER SERVICE SERVICE Address: APPLICANT First Name: Middle Initial: Last Name: Mailing Address/City/St/Zip: Home Phone: Cell Phone: Emergency Phone: Social Security Number: Date of Birth: Driver s License : Employer: Work Phone: CO-APPLICANT First Name: Middle Initial: Last Name: Social Security Number: Date of Birth: Driver s License : Employer: Work Phone: Size of Home: # of Occupants: Pool on Premise: Own Home: Rent Home *: *Please complete Landlord Information below Landlord Name: Landlord Phone Number.

7 I/We hereby apply for WATER SERVICE at the address above under the terms and conditions as approved by the Arizona Corporation Commission and agree to pay for the same at the approved rates. Applicant Signature: Date: Co-Applicant Signature: Date: Page 2 of 3 ARIZONA CORPORATION COMMISSION Rules & Regulations for Easements and Rights-of-Way The following is very important to the safety and welfare of your family as well as our employees. These rules must be complied with at all times. EASEMENTS and RIGHTS-OF-WAYS 1. Each customer shall grant adequate easement and right-of-way satisfactory to the utility to ensure that customer s proper SERVICE connection. Failure on the part of the customer to grant adequate easement and right-of-way shall be grounds for the utility to refuse SERVICE . 2. When a utility discovers that a customer or his agent is performing work or has constructed facilities adjacent to or within an easement or right-of-way and such work, construction or facility poses a hazard or is in violation of federal, state or local laws, ordinances, statutes, rules or regulations, or significantly interfered with the utility s access to equipment, the utility shall notify customer or his agent and shall take whatever actions are necessary to eliminate the hazard, obstruction or violation at the customer s expense.

8 GROUNDS FOR REFUSAL OF SERVICE A Utility may refuse to establish SERVICE if any of the following conditions exist: 1. The applicant has an outstanding amount due for the same class of utility SERVICE and the applicant is unwilling to make arrangements with the utility for payment. 2. A condition exists which, in the utility s judgment, is unsafe or hazardous to the applicant, the general population, or the utility s personnel or facilities. 3. Refusal by applicant to provide the utility with a deposit. 4. Customer is known to be in violation of the utility s tariffs filed with the Commission or of the Commission s rules and regulations. 5. Failure of the customer to furnish such funds, SERVICE , equipment, and/or rights-of-way necessary to serve the customer and which have been specified by the utility as a condition for providing SERVICE . 6. Applicant falsifies his or her identify for the purpose of obtaining SERVICE .

9 I have read and understand the rules and regulations above. Applicant Signature: Date: Co-Applicant Signature: Date: Page 3 of 3