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Residential Utility Application

Residential Utility Application

The Service Effective Date* requested below will determine the date of the beginning or end of your service. It is also the date we will read your water meter. Water meters are read M-F from 8am to 5pm. Please allow 1 to 3 days, from the Effective Date, for meter reading. Thank you!


ALERT:  The form below is to be used for New and Discontinued Service requests. Please submit a separate form for each type of service


 

TYPE OF SERVICE REQUEST 
New ServiceYes   No
Discontinue ServiceYes   No
Do you own property?Yes   No
NEW SERVICE REQUEST 
New Service Property Address:
Is this a new house?Yes   No
New Service Effective Date:*
DISCONTINUE SERVICE REQUEST 
Discontinue Service Address:
Forwarding Address - for Final Bill
Forwarding City, State, and Zip Code
Discontinue Service Effective Date:*
BILLING INFORMATION 
Last Name:
First Name:
Additional Name - (Spouse, etc.):
Mailing Address or PO Box:
City, State and Zip Code
Phone Number
Email Address
Transfer ACH payment to new address?Yes   No

 



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