HIGHLAND DITCH COMPANY
4309 STATE HWY 66
LONGMONT, CO 80504
Tenant Information needs to be received prior to
running ANY water!
STOCKHOLDER(S) INFORMATION Account No. ____________
NAME:_________________________________________________________________
ADDRESS:______________________________________________________________
CITY: ________________________ STATE: _________________ ZIP______________
PHONE NUMBERS:
DAY: ______________________________________________
NIGHT: _____________________________________________
TENANT(S) INFORMATION
Below list person(s) who you are authorizing, as the shareholder, to order water from your account for 2008.
NAME: __________________________________ PHONE NO. ___________________
NAME: __________________________________ PHONE NO. ___________________
Are the above tenant(s) allowed to move water in and out of your account and or the Highland System?
_____ YES
_____ NO
*_________________________________________ DATE: _______________________
Shareholder(s) Signature / if Entity state your position