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2. Letter of Authorization

   Please be advised that by this Letter of Authorization, the undersigned WaterOne Customer authorizes the designated Agent to act as an agent on its behalf in matters related to the following:

   Actions Authorized:

   • Initiate or discontinue water service.
   • Issue payments to WaterOne.
   • Discuss any necessary changes to make the payables process more efficient.
   • Receive any related communications from WaterOne directly at the address designated below.

   WaterOne will send a confirmation email to the address associated with the account. 

6. WaterOne Customer Account Name*
7. Email Address Associated With WaterOne Account*
8. WaterOne Account Number
10. Service Address*
12. City*
13. State*
14. Zip Code*
16. Phone Number*
20. Name of Agent*
21. Email Address*
23. Address*
25. City*
26. State*
27. Zip Code*
29. Phone Number*
33. Date to Begin Authorization*
    Date to Begin Authorization
35. Terms & Conditions

    Term: The term of this Authorization is twelve (12) months beginning on the date written above. After the initial term expires, this Authorization shall continue on a month-to-month basis until terminated by either party upon thirty (30) days written notice to the other party. 

    Indemnification: Agent shall be guarantor for all indebtedness incurred related to this Authorization. In the event there shall be any default in payment or other violation of WaterOne’s Rules and Regulations with respect to such Authorization. Further, Agent shall indemnify and otherwise hold WaterOne, its officers, employees, agents, and board members harmless from any loss or damage WaterOne may sustain from non-payment, loss or damage regardless of whether Agent’s actions causing such damage were within the scope of this Authorization. 

    Notices: Any written notice related to this Authorization shall be sent to the address designated here.

    Confidentiality: Agent shall use reasonable efforts to maintain the confidentiality of information provided to or obtained by Agent which a reasonable person would know is confidential and Agent shall use such information only as necessary in performing in accordance with this Authorization and for no other purpose.

    Law: All services provided by the Agent shall comply with all applicable federal, State, and local laws as well as WaterOne’s Rules and Regulations. This Authorization shall be governed by the laws of the State of Kansas. 

    Entire Agreement: This Authorization contains all the terms agreed to by the parties relating to its subject matter. This Authorization replaces all previous discussions, understandings, and oral agreements. 

    Authority to Sign: The individual signing this Authorization on behalf of the WaterOne Customer represents and warrants that they are fully authorized to execute this Authorization on behalf of and bind the WaterOne Customer to the terms set forth herein. 

37. Agreement*

    The undersigned certifies that they are signing as the WaterOne Customer and have reviewed, understand, and agree to be bound by this Letter of Authorization. The undersigned agrees that an electronic signature on this Letter of Authorization shall be considered legally binding and equivalent to a handwritten signature.

    1. I Agree
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

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