Application for Water Service

Account Type *

New Account – Establish a new account
Existing Account – Update your account information

Water Service Type *

Residential Water Service
Commercial Water Service

Applicant's Information

Business Name (if applicable)

Business Type

Applicant's Legal Name *

First

Last

Applicants Email Address *

Email

Confirm Email

Applicant's Primary Phone Number *

Applicant's Secondary Phone Number *

Applicant's Drivers Licence or State ID # *

Alternate Contact

Alternate Contact Name

First

Last

Alternate Contact Email

Alternate Contact Phone Number

Property & Billing Information

Water Service Address *

Address Line 1

Address Line 2

City

State

Zip Code

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you the owner or a renter? *

Owner
Renter

Landlord's Name

First

Last

Landlord's Email

Landlord's Phone Number

Closing Date

When do you plan to close on the purchase of the property?

Move in Date

When do you plan to move in?

Agreement & Signature

Service Agreement *

I agree to comply with the utility’s tariff and I understand that failure to comply can result in a suspension of water service. I agree to provide safe and unobstructed access to utility employees or agents where access is required and to promptly pay all water utility that are due. I agree I will not obstruct my keybox and will maintain it in working order as required the water utility’s tariff. I understand that all expenses incurred in the repair of my keybox are my responsibility and that a $70 disconnect fee and a $70 reconnect fee will be charged if service is suspended for any reason. I understand all unpaid tenant charges are the property owner’s responsibility.

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to this application.

Digital Signature *

By typing your full name here, you confim that the information given in the above form is correct, and that you agree to the terms described above.

Date *

Please enter the date which you are digitally signing this agreement.

Applicant's Information

Alternate Contact

Property & Billing Information

Agreement & Signature

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