System Membership – Registration or Renewal | Arkansas Rural Water Association

Legal Entity Name*

County*

Phone*

Fax

Email*

Cell Phone

Name of cell phone contact

What is your population served?*

Facility Locations to be covered by membership

Facility Name	Facility Address	Actions

There are no Facility Locations.

Total Facility Fee*

Price: $0.00

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 Fund

Other amount*

Total Payment Due