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645 Beacon Lite Road, Monument CO 80132 I p: [PHONE REDACTED] I email: [EMAIL REDACTED] Hydrant / Construction Meter Request Date of Application Project Location Company Name Contact and Billing Information: Contact Name Mailing Address City State Zip Phone Number Email Address What will water be used for? How long will you need meter? Avg amount per week (gals)? Estimated total amt to be used? • Construction meters are to be read and billed once per month and due by the 20th of the following month • To submit a meter reading, please submit a photo of the meter read by the 25th of every month. Email to: [EMAIL REDACTED] • $12.50 late fee charge for payments not received by the 20th of the month • $25.00 insufficient fund charge • Disconnect notice: $20.00 if notice is posted/mailed ☐ Paperless Billing ☐ I agree to the terms, conditions, and restrictions of this application and all applicable requirements related to the use of Town of Monument water pursuant to the Town of Monument Municipal Code, Chapter 13 – Public Services Customer Signature Date Below for Internal Use Only Meter ID # Read When Checked Out: Date Checked Out: Hydrant Wrench Taken? Hydrant Hose Taken? Date Meter Returned: Checked in by: Returned in good condition? Final Picture Attached? Approved By: Date: