Utility Service Application and Agreement

Utility Service Application and Agreement
Instructions: Please complete all sections of the form that apply to you. Please be sure to have the following documents available when opening an account. A deposit is required for all new accounts. Water accounts can only be made in the property owner’s name.
Today's Date

MonthDayYear

Hour MinutesAM/PM Option
Is this a new account
Is this a residential / commercial account?
Proof of Ownership

Upload for All New Services | Max file size: 25 MB, Accepted file types: .pdf, .jpg, .png
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Applicant's Information
Applicant Name

First NameLast Name
E-mail Address
example@example.com
Contact Number
Add your best contact to reach you.Format: 000-000-0000.
Is the service address the same as the billing address?
Service Start Date

MonthDayYear
Monday – Friday Only | No Weekend Schedule
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code
Service Address

Street Address

Street Address Line 2

CityState

Zip Code
Residential Account
Drivers License State
Drivers License Number
Upload only front picture of your drivers license

Send only Front
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Commercial Accounts
Tax ID number or EIN
Upload proof of Tax ID number or EIN

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Applicant Agreement

Applicant must read and sign
Applicant acknowledges and agrees to the terms below,
By typing my name in the below space, I am electronically signing this form. My signing this electronic signature certifies the information to be true, accurate, and complete.

First NameLast Name
Should be Empty:

Utility Service Application and Agreement

Applicant's Information

Residential Account

Commercial Accounts

Applicant Agreement