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2. Company*
3. Name of Authorized Representative*
5. Billing Address: Street*
7. Billing Address: City*
8. Billing Address: State*
9. Billing Address: Zip Code*
11. Phone Number*
12. Email
14. Hydrant Location*
16. Alternate Hydrant Location
18. Requested Set Date*
    Requested Set Date
19. City Project*

    1. YES

    1. NO
21. Acknowledgement*

    Applicant agrees to the following stipulations when requesting placement of a hydrant meter:

    •    Applicant is responsible for any/ all damages to the meter or hydrant, including from freezing.

    •    Applicant is responsible for all fittings and accessories, including but not limited to pad locks and hose adapters. A fee for any missing or damaged items may be assessed. 

    •    If there is no usage reported by the meter within a one (1) month period, the meter will be removed by City staff.

    •    The use of a garden hose with the meter equipment is prohibited and will void the service agreement, resulting in removal of the meter by City staff. The meter is equipped to accommodate a 2 1/2” fire hose ONLY.

    •    No party other than City staff are authorized to operate City owned hydrants.

    Submission of this application does not guarantee service. Please, allow adequate time for evaluation of application and placement of meter. Contact the Field Services Manager for assistance at 406-657-8331.

    1. I agree
23. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
25. Electronic Signature*
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field