Chino Valley, AZ · Yavapai County
Fill Station Application
The Fill Station Application collects applicant details and a signature from people applying to use a listed water fill station in Chino Valley.
What this form is
This application is for people seeking to use a water fill station at one of the locations listed on the form. It asks for applicant contact and address information, a signature, and office-use details including a member number and PIN. The form also states that account setup incurs a non-refundable $25 administrative fee and notes that haulers may submit an Arizona Resale Certificate for tax exemption consideration.
Who needs it
People applying to use one of the listed water fill stations need to complete the applicant information and sign the application.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This application is signed and dated without a notary; the form does not identify any notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Application
Download the Fill Station Application PDF.
- 2
Complete Applicant Information
Fill in your name, address, email, phone number, city, state, and ZIP code.
- 3
Sign And Date
Sign and date the application. The form does not identify a notarized or sworn attachment.
- 4
Submit To The City
Submit the completed application to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What information does the Fill Station Application ask for?
- It requests applicant name, address, email, phone number, city, state, ZIP code, and signature. It also has office-use fields for a member number and PIN.
- Do I need a notary for the Fill Station Application?
- No. The application is signed and dated without a notary, and it does not identify any notarized or sworn attachment.
- How do I submit the Fill Station Application?
- Submit it to the city department named on the form; check the city website for current contact details.
- Does the form mention a fee?
- Yes. It states that a non-refundable $25 administrative fee is charged upon account setup.