HomeMy WebLinkAboutBulkWaterApplicationCITY OF OSHKOSH
BULK WATER APPLICATION
Company Name:______________________________________________
Address 1:____________________________________________________
Address 2:____________________________________________________
City: ___________________________ State: _______________ Zip: __________________
Contact Name:______________________________________________________
Phone #: (_____) _____‐________________ FAX #: (_____) _____‐________________
Cell #: (_____) ______‐_____________ Email:________________________________________
Fill out separate line for each driver that may pickup bulk water. An Access number will be assigned by
the Water Utility. Each driver should choose a different four‐digit PIN number. When a completed
application is received at the Water Utility, the Utility will return a copy to the customer with the
assigned Access numbers. RETURN FORMS TO: CITY OF OSHKOSH WATER DISTRIBUTION CENTER
757 W 3RD AVENUE
OSHKOSH WI 54902
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___
Driver: ________________________________ Access #: PIN#: ___ ___ ___ ___