Forms

Below is links to forms that customers may find useful in doing business with HWPUD.  All forms are pre-fillable or available at the District’s office, located at 87845 Hwy 101 Florence OR 97439. Complete online and email to us at customer-service@hwpud.com. You can also print, complete, scan forms or drop forms off at the office, mail or fax to 541-997-1059. 

Water Service Application – all new customers need to submit a completed copy of this form to apply for water service in HWPUD.  We will need to see a photo ID for verification.  There is a one-time application fee that will be added to your first bill. Refer to our Rates and Fees page for current charges.  

Customer Assistance Program – The Board of Directors has passed a resolution (Resolution 2014-12) to help low-income customers with their water bills. Please read this form to see if you can qualify for this assistance.

ACH for Checking Accounts – we can arrange an automatic payment from your checking account after we receive this form from you along with a voided check.  You will still receive a copy of the bill so that you will know how much water you used and how much we will be taking out of your account.  We arrange that auto-pay to come out of your account on the 25th of the month, when the bill is due.

EFT for Debit/Credit Cards – If you would like to arrange for automatic payments through a bank card/credit card, fill out this form and turn it in to the office.  You will still receive a monthly paper bill, so that you know how much will be charged to your credit card on the 25th of the month, when the bill is due.  We will honor all credit cards and debit cards.