"*" indicates required fields Legal Entity Name*County*Select...Arkansas CountyAshley CountyBaxter CountyBenton CountyBoone CountyBradley CountyCalhoun CountyCarroll CountyChicot CountyClark CountyClay CountyCleburne CountyCleveland CountyColumbia CountyConway CountyCraighead CountyCrawford CountyCrittenden CountyCross CountyDallas CountyDesha CountyDrew CountyFaulkner CountyFranklin CountyFulton CountyGarland CountyGrant CountyGreene CountyHempstead CountyHot Spring CountyHoward CountyIndependence CountyIzard CountyJackson CountyJefferson CountyJohnson CountyLafayette CountyLawrence CountyLee CountyLincoln CountyLittle River CountyLogan CountyLonoke CountyMadison CountyMarion CountyMiller CountyMississippi CountyMonroe CountyMontgomery CountyNevada CountyNewton CountyOuachita CountyPerry CountyPhillips CountyPike CountyPoinsett CountyPolk CountyPope CountyPrairie CountyPulaski CountyRandolph CountySt. Francis CountySaline CountyScott CountySearcy CountySebastian CountySevier CountySharp CountyStone CountyUnion CountyVan Buren CountyWashington CountyWhite CountyWoodruff CountyYell CountyMailing Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Physical Address(if different from above) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Manager or Operator First Last Mayor or Board President First Last Office Contact* First Last Phone*FaxEmail* Cell PhoneName of cell phone contactWhich congressional district?* Congressional District #1 Congressional District #2 Congressional District #3 Congressional District #4 What is your ARWA District?* Central District (Faulkner, Lonoke, Monroe, Prairie, Pulaski, and Saline) Eastern District (Clay, Craighead, Crittenden, Cross, Greene, Lawrence, Lee, Mississippi, Phillips, Poinsett, Randolph, and Saint Francis) Northwest District (Baxter, Benton, Boone, Carroll, Madison, Marion, Newton, Searcy, and Washington) Southeast District (Arkansas, Ashley, Bradley, Cleveland, Chicot, Desha, Drew, Grant, Jefferson, and Lincoln) Southwest District (Calhoun, Columbia, Dallas, Hempstead, Howard, Lafayette, Little River, Miller, Nevada, Ouachita, Sevier, and Union) West Central District (Clark, Conway, Garland, Hot Spring, Johnson, Montgomery, Perry, Pike, Pope, and Yell) Western District (Crawford, Franklin, Logan, Polk, Scott, and Sebastian) White River District (Cleburne, Fulton, Independence, Izard, Jackson, Sharp, Stone, Van Buren, White, and Woodruff) What is your population served?*Are you a One-Call Member? Yes No System Type* Municipality <10,000 Municipality >10,000 District Association Facilities Board Public Water Authority Regional Water Distribution District Sustaining (Includes state agencies, schools, industrial facilities, property owner associations, etc.) Wholesale Water Provider Facility Locations to be covered by membership Facility Name Facility Address Actions Edit Delete There are no Facility Locations. Add Facility Location Maximum number of facility locations reached. Total Facility Fee* Price: $0.00 What kind of system are you?* Water System Wastewater System Water & Wastewater System Number of Water connections*(Number of connections will be checked against lists provided by the Arkansas Department of Health and Arkansas Department of Environmental Quality.)Number of Wastewater connections*(Number of connections will be checked against lists provided by the Arkansas Department of Health and Arkansas Department of Environmental Quality.)Basic Rate: Tier A Price: $0.00 Basic Rate: Tier B Price: $0.00 Basic Rate - Wholesalers Price: Connection Fee* Price: $0.00 Donate to the Ernie Faucett Scholarship FundSelect...$25$50$100Other amountNo Thank YouOther amount* Total Payment Due How do you wish to pay?* Pay now online Pay by invoice Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
