Water Service Application

Water_Service_Agreement

Service Type Requested:

Start Utility Service

Stop Utility Service

After completing and submitting this form you will be required to stop at Cityhall to complete the Account setup process.

A deposit of $200.00 is required to setup a new utility account. (Cash or Check)

We will need a copy of your current drivers License.

Date Requested for service to Start:

Date Requested for service to Stop:

First Name

Last Name

Service Address

Address Line 2

City

State

Zip Code

Check if Billing address is same as Service address:

Billing address is same as Service Address

Billing Address

Address Line 2

City

State

Zip Code

Phone Number

By checking this box and providing an E-Mail address you will not receive a paper bill. Your bill will be emailed to the E-Mail address provided.

E-Bill Requested

Email address for e-bill

Please list all occupants over the age of 18

Co-occupant 1:

Co-occupant 2:

Occupant Type:

Homeowner

Renter

Special Notes