2. This form will send an outside watering meter pick-up request to the Grinnell Water Department. Submit one form per address.
4. Place the watering meter to be picked up outside your home the morning of the next business day (Monday-Friday). Water department staff will pick up the meter.
6. Owner Information
8. Name on City Utility Account*
10. Address Requesting Outside Watering Meter Pick Up*
11. Contact Person (if different from above)
13. Contact Number*
14. Alternate Contact Number
15. E-mail Address
17. Is there more than one meter to be picked up at this ddress?*

    1. No
    2. Yes
18. Total Number Meters to be Picked Up*
20. Place the water meter in the general location as it was originally delivered. Water department staff will pick up the meter on the business day following submission of this form.

22. THE CITY’S POLICY IS TO RELEASE METERS ON OR AFTER MAY 1ST TO CUSTOMERS WITH THE UNDERSTANDING THAT THE METER IS TO BE RETURNED TO THE WATER DEPARTMENT BY OCTOBER 1ST OF THE SAME YEAR. THE UNDERSIGNED UNDERSTANDS THAT IF THE WATER METER SHOULD BE FROZEN, DAMAGED, OR STOLEN THE UNDERSIGNED WILL BE RESPONSIBLE FOR THE REPLACEMENT OF THE WATER METER. THE CURRENT COST OF A WATER METER IS $149.50 (SUBJECT TO CHANGE).

24. Electronic Signature of Owner or Owner's Representative*
26. Date*
    Date
Leave This Blank:


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

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field