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Commercial Request for Service
Service Start Date
*
🛈
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Preferred Service Connection Time:
*
🛈
Morning
Afternoon
Customer Name
*
Service Street Address
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Is Mailing Address the same as the Service Address?
*
Yes
No
Mailing Address (If different than Svc Address)
Mailing Address City
Mailing Address State
Mailing Address Zip Code
Phone Number
*
Alt Phone Number
___________________________________________________________________________________________________________________________
Business Tax ID #
*
Name of Person requesting service:
*
Upload Copy of Tax ID Document
Would you like to recieve an e-bill?
Please select Yes or No
*
Yes, I would like to receive an E-bill
No, I do not want to receive an E-bill
Please Select One
E-mail Only
E-mail and Paper Statement
E-mail Address:
By entering my full name and clicking ‘Submit’ below, I am providing my electronic
signature and verifying that the information I have provided on this form is true
and correct, and I am authorized to initiate new water service for the address
listed on this application.
*
Date signed
*
+
Acknowledgement
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Disconnection of service for non-payment does not close a utility account. The account may continue to bill until the account holder contacts the Utility Business Office to terminate the account. Customers will be held responsible for charges to the utility account as long as it is active in the customer’s name. Please contact the Utility Business Office to close your account when service is no longer needed.