Application for Water Service

This is a legal contract. Please read all the terms and conditions below before submitting this form.

  • Quality Water from Adair Co. PWSD #1

    Applicant should be at home when water service is turned on. Applicant assumes all responsibility for any open outlets resulting in water loss or damages.

  • Applicant contractually agrees to pay all water charges to this Water District until said applicant has terminated service to this residence.
  • Applicant hereby agrees to abide by all rules and policies established by said Water District and any hereafter established.
  • District reserves the right to discontinue water service at this residence without further notice if rules, regulations, and policies have not been followed.
  • The undersigned agrees that in the event any part of the water system of the undersigned constructed, expanded, modified or repaired after January 1, 1989, is found to contain materials that are not "lead free" the District shall have the right to remove the water meter serving the undersigned and shall have the right to sever the service line serving the undersigned. The definition of "lead free" as used herein shall be as defined in the Rules and Regulations of the Missouri Department of Natural Resources as it now exists and as it may from time to time hereafter by redefined by it.
  • This service is provided on an equal opportunity basis.


  • You should receive a bill by the 1st of each month.
  • If you fail to pay by the 15th of the month - add 10% penalty.
  • Accounts not paid by the 30th of the month will be subject to a disconnection WITHOUT FURTHER NOTICE.
  • Consumers disconnected for non-payment will be charged a $50.00 reconnection charge.

Please read all the terms and conditions above before reading and submitting this form.

    Select One:

    Primary use of water:

    By checking here, I agree to all terms and conditions listed in this application