Forms

Here are links to forms that customers may find useful in doing business with HWPUD.  All of these forms are also available at the District’s office.  We can also mail or email forms to you, if needed.

Water Service Application – all new customers need to submit a copy of this form to apply for water service in HWPUD.  We will need to see a photo ID.  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.  These applications can be dropped off at the office, mailed to 87845 Hwy 101, Florence, OR  97439, faxed to us at 541-997-1059, or scanned and emailed to us at customer-service@hwpud.com

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 around 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 can mail (87845 Hwy 101  Florence, OR  97439) fax (541-997-1059) or drop it off at 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.