Community Water
1501 S La Canada Dr.
Green Valley, AZ 85622
Phone: 520-625-8409
Fax: 520-625-1951
Round Up Application
1 Select
Cost: FREE
Notes:

Round-Up Agreement:

1. I hereby authorize Community Water Company of Green Valley to Round-Up my Water Bill either to the next whole dollar amount and\or an additional dollar amount that I specify.

2. I have the right to withdraw from Round-Up by notifying Community Water Company within five (5) business days of the billing date.

3. If my account should ever be in arrears, I will be withdrawn from the plan.

4. I understand that Community Water Company reserves the right to terminate this plan and\or my participation therein.

5. I understand that Community Water Company will forward the monies collected from the Round-Up Program to a local Charity for the purpose of helping other Community Water Company customers with the payment of their water bills.
Registration Information
First Name:*
Last Name:*
Address:*
City:*
State:*
Zip:*
Phone:*
Email:
Please select option:*
Option 2: Amount:
Account Number:*
Customer Acceptance Electronic Signature:*

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