Online Applications

Medical Certification

Welcome to Tontitown Water Utility’s Medical Certification application. Follow the step-by-step process to complete the Service application.

Once you have submitted your online application, TWU staff will review your application and contact you if there are any questions.

Please refer to Section I, Chapter 3, 1.3.1 – “LIFE SUPPORT” Utility Accounts on our Terms and Conditions of Service for information about Medical Certifications. Click here to download and read the TONTITOWN WATER UTILITIES TERMS AND CONDITIONS OF SERVICE.

Medical Certification

Staff Use:

Customer Certification

Customer's Name: *

Email: *

Customer's address: *

Customer's address:

City

State/Province

Zip/Postal

Phone (day): *

Phone evening):

Designated Emergency Contact:

Emergency Contact Name: *

Relationship: *

Address:

City

State/Province

Zip/Postal

Phone (day): *

Phone (evening):

Type of equipment: *

Location of equipment: *

Does the customer have a back-up system? *

Yes

What type of back-up system is available?

Back-up system time limit:

Expected duration of medical condition: *

By completing this certification, I certify that the information provided herein is accurate to the best of my knowledge. Should my situation change or should I leave the residence I will promptly notify Tontitown Water Utility. I acknowledge that I understand that this certification does not relieve me of my responsibility to pay for utility services that are consumed at my address.

Signature: *

Clear

Date: *

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Water & Sewer

Angela Russell – Mayor
mayor@tontitownar.gov
Jamie Malone - Administrative Assistant to the Mayor
adminasst@tontitownar.gov
Luann Jenison - City Administration / HR
cityadmin@tontitownar.gov

Tontitown City Administration Building & City Hall

Open from 8:00 am till 4:30 pm. Offices Located in this building are Administration, Accounting, Building, Planning, and Public Works Department.

Located at:
235 E Henri de Tonti Blvd
Tontitown AR 72762
(Located in Tontitown next to the Park)
Mailing Address:
PO Box 305, Tontitown AR 72770

Tontitown Water Utility
Mailing Address: PO Box 127, Tontitown AR 72770
Physical Address: 201 E Henri de Tonti Blvd, Tontitown AR 72762

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Tontitown City Administration Building

235 E Henri de Tonti Blvd
Tontitown AR 72762
Mailing Address:
PO Box 305, Tontitown AR 72770

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Hours

Mon-Fri: 8:00 am - 4:30 pm
Sat-Sun: Closed

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Call Us

479-361-2700