Clifton Park Water Authority - CPWA

Applicant*

Please let us know your name.

Address*

Address is required

City*

City is required

Email*

Email Address is required

State*

State is required

Phone Number*

Phone number is required

License Plate*

License Plate is required

Use of Water*

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Start Date

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Return Date

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Total Working Days:*

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EQUIPMENT RENTED

Backflow Prevention Device, Gate Valve and Hydrant Wrench

*

¾” ($50/day)

2 ½” ($75/day)

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Total Rental Charge

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EQUIPMENT DEPOSIT in the form of cash, check or money order

¾” ($500.00)

2 ½” ($750.00)

Deposits will be refunded on the satisfactory return of equipment.

By Signing below the permitee agrees that the equipment rented will be returned in working order and without damage within the timeframe stipulated above. Failure to return the equipment by the return date will result in loss of equipment deposit.

Date

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Signature (Please type in full name)*

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*

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Hydrant Equipment Rental