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.)

Hidden

Total Connections*

This field is used to determine which price tier is used for basic membership rate.

Basic Rate - Tier 1A

0-1,000 Connections for Water or Wastewater Only

Price:

Basic Rate - Tier 1B

0-1,000 Connections for Water and Wastewater

Price:

Basic Rate - Tier 2A

1,001-2,000 Connections for Water or Wastewater Only

Price:

Basic Rate - Tier 2B

1,000-2,000 Connections for Water and Wastewater

Price:

Basic Rate - Tier 3A

2,001+ Connections for Water or Wastewater Only

Price:

Basic Rate - Tier 3B

2,001+ Connections for Water and Wastewater

Price:

Basic Rate - Wholesalers

Price:

Hidden

Membership Fee Subtotal

Hidden

Connections Fee Subtotal

Hidden

Subtotal

Per Connection Fee*

Price: $0.00

Per Connection Fee (Capped)*

Price: $0.00

Donate to the Ernie Faucett Scholarship Fund

Other amount*

Total Payment Due