District Forms

Overview
Our Office encourages its customers to download their forms via the internet whenever possible.  Please be aware that all forms/applications must be submitted via the US Mail or in person.  No forms or applications will be accepted electronically.  We require an original signature on all forms.  In the case the form requires a Notary Public, the form may be filled out in advance, but you must wait to sign and date them until you are actually in the presence of the Notary official.  The forms listed below are available in electronic format.  Just click the item you want.  The form will open automatically if Adobe Reader is installed on your computer.

Direct Debit Authorization Form  Water District customers have the option of having their water bill payments automatically deducted from their checking account by completing the Direct Pay Authorization Form.  This form is not submitted online - Completed forms, accompanied by a "VOIDED" check from the checking account that will be debited, must be hand-delivered or mailed to the address listed below.

Service and Billing Agreement Card   Customers wishing to open an account for water service must complete a Service and Billing Agreement Card and submit a $40.00 application fee prior to activating an account.  The Service and Billing Agreement form will ask for the customer’s name, service address, mailing address, date service is to begin, telephone number and employer information.  The Water District requires an original signature on all Service and Billing Agreement forms (faxed or digital versions of the forms will not be accepted).

Application for Tenant Billing  Accounts may be billed to tenants as a convenience to the owner upon filing of the Application for Tenant Billing form.  Although, all charges for water will be the ultimate responsiblity of the property onwer. 

Special Services Request Form  Use this form to request any type of Public Information from the Water District.

Public Records Act Request Form  This form lets you request public information pursuant to the California Public Records Act (Section 6250 and following of the Government Code). 

Service Discontinuance Request  Use this form to terminate/discontinue service.

Agriculture Customer Activation/Discontinuance  Agriculture Customers must use this form to request water service activation or discontinuance.

Water Service Application Page 1  Download Page 1 and 2 of the Water Service Application.
Water Service Application Page 2

Toilet Rebate Program and Application    Download this form for the Water District's Toilet Rebate Program and Application.

Low Flow Showerhead Program Form  The Santa Ynez River Water Conservation Improvement District #1 is continually looking for ways to help our customers conserve water and save on utility costs.  We now offer free low-flow shower heads to District customers.  The low-flow shower heads have a maximum flow rate of 2.5 gallons per minute with adjustable settings.  Download the application and guidelines here.