Request for Service - Commercial

Commercial Request for Service

Service Start Date * 🛈 +

Preferred Service Connection Time: * 🛈

Morning

Afternoon

Customer Name *

Service Street Address *

Is Mailing Address the same as the Service Address? *

Yes

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 *

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.