Primary Account Holder * Name: Service Address: * Alternate Mailing Address: Phone Number: * Email: Required for estatements Driver License Number or Social Security Number * Secondary Account Holder optional Secondary Phone Number: Social Security or Driver License Number Property Information * Homeowner Renter If you own the home, will it be used as a rental property? yes no Move in Date: * Date you will start being billed for services Bill Preference: * Printed Email Both Signature: * I agree to the following: Water service may be suspended at any time if a previous balance is owed to another utility company. Damage to meter or contents of meter box is your responsibility, tampering with the meter can result in a fee up to $300.00. Homeowner deposit- $75.00 Renter Deposit- $175.00 Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Driver License * Files must be less than 5 MB.Allowed file types: gif jpg jpeg png txt pdf doc. Leave this field blank
