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8. Complete and submit this enrollment form
   Fill in the following information and submit the form to enroll in the SIM Program. Also, you need to provide the Wastewater Department with an initial meter reading.
10. Account #*
    Wastewater Account
12. First Name*
13. Last Name*
15. Service Address*
17. Email Address
18. Phone Number
20. Meter Information*
    Provide the make and model of your irrigation meter or controller.
21. Meter Unit of Measure*
    -- Select One --GallonsKgalsCCFsOther

    If "Other", describe in Meter Information field.
23. Initial Meter Reading
    Upload an image of your initial meter reading. The image may be a picture of the meter and/or a screen shot of any digital reading, as applicable. Contact customer support if you need assistance.
25. Terms and Conditions
    I hereby certify and agree as follows:
27. I am the account holder of the above Sahuarita Wastewater account, and I hereby apply to enroll in the Standalone Irrigation Meter (SIM) Program. I have read, understand, and agree to comply with the SIM Program Rules. I understand that my account will be assessed an additional fee for participation in this program. I agree that any Irrigation Meter Readings that I submit shall be accurate and true, and I understand that filing false data is a felony, and is subject to penalties under Arizona law, including imprisonment. I understand that I may cancel my participation in this program at any time by providing written notice to the Sahuarita Wastewater utility, and if I do so, I will not be allowed to participate in the program again for a minimum of one year after cancellation. I understand that the Sahuarita Wastewater Utility may modify, suspend, or cancel, the SIM Program at any time, either for my account, some accounts, or all accounts.
29. Authorizing Signature*
    Type first and last name to accept the terms and conditions.
30. Date*
    Date
    Date of form submittal
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field