Skip to content
Home
Information
FAQ’s
News
Development
Backflow
Forms
Staff
Contact
Pay Online
Home
Information
FAQ’s
News
Development
Backflow
Forms
Staff
Contact
Pay Online
Application For New Service
New Service Application
Customer Type
Owner/Purchase
Rental/Lease
Requested Start Date
Service Address
City
State
Zip
Original Applicant Full Name
Date of Birth
Driver License/ID Number
Phone Number
Email Address
Mailing Address
City
State
Zip
Additional Adult Applicant #2
Date of Birth
Driver License/ID Number
Phone Number
Email Address
Additional Adult Applicant #3
Date of Birth
Driver License/ID Number
Phone Number
Email Address
Lease Start Date
Landlord Name
Landlord Phone Number
Is Tap On Applicant Property
Yes
No
If not, Easement Is Required
Acknowledged
Non-Refundable Service Charge
I acknowledge and Accept The Non-Refundable Service Charge.
ID Acknowledgement
I acknowledge that all adults must provide ID.
Primary ID
Additional ID's Requirement
If additional ID's are required for service, I acknowledge and have provided the additional ID's.
Additional ID's
Lease Requirement
If a lease is required for service, I acknowledge and have provided the lease.
Lease (for rentals)
Easement Requirement
If an easement is required for service, I acknowledge and have provided the easement.
Easement (if applicable)
Certification of Accuracy
I, the undersigned, hereby certify that the information provided in the attached form and all supporting documentation is true, accurate, and complete to the best of my knowledge, information, and belief. I understand that any willful misrepresentation or omission of material facts may result in the rejection of this application.
Terms of The Contract Acknowledgment
I, the undersigned, fully understand and agree to the terms of the water service contract.
Signature (full name)
Date Signed
Submit Application
