New Water Service Application

1Primary Account Holder Information

2Secondary Account Holder Information

3Contact Information

What type of service are you applying for?*
- Residential
- Commercial
Name of Business?*
Name:*
First Last
Do you currently have an account with us?*
- Yes
- No
What is your current address?*
New Service Address:*
Billing Address*
Do you rent or own the property where you are applying for service?*
- Own
- Rent / Lease
Landlord Name:*
Date for Start of Service:*
MM slash DD slash YYYY

we cannot start service more than 7 days in advance
Tax ID Number?*
Social Security Number:*
Driver's License or ID Number*
Drivers License State*
Date of Birth*
MM slash DD slash YYYY

You must be at least 18 years old to start new water service in your name.
Phone Number*
Email*
Enter Email Confirm Email
Emergency Contact Name*
First Last
Emergency Contact Phone Number:*
Place of Employment*
if unemployed, student, or retired please designate
Please upload the following documents:

1) Your ID (Your driver’s license is preferred. If you do not have a driver’s license, please submit a copy of your state ID, passport or other legal identification.)
2) RENTAL PROPERTY: Please submit a copy of the first page of your lease with the landlord’s name, the tenant’s name(s), and the address along with a copy of the signature page.
PURCHASING: if you are buying your home, please submit a copy of your Real Estate Purchase Agreement. Note: if you have questions about what you need to submit, please call (620) 231-4100 for assistance.
Please upload the following documents:

1) Tax ID
2) RENTAL PROPERTY: Please submit a copy of the first page of your lease with the landlord’s name, the tenant’s name(s), and the address along with a copy of the signature page.
PURCHASING: if you are buying your property, please submit a copy of your Real Estate Purchase Agreement. Note: if you have questions about what you need to submit, please call (620) 231-4100 for assistance.
Please remember to click the blue upload button above this before proceeding to the next step.
Note: We are asking you fill in the fields above again for additional security verification.

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New Water Service Application

Contact Information