Residential Application / Termination Form

**For residential service only**

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Service Address *

Account Number *

If you are an existing customer, please enter your utility account number. For new customers, please feel free to leave blank, and an account number will be generated for you.

Landlord / Owner *

I am *

Buying

Selling

Renting

Date to Read Meter

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This is the date you are first responsible for the water/sewer at the service address if moving in, or the last date you are responsible for water/sewer if moving out.

Moving In

Information for NEW responsible customer (Tenants: If you are moving out and don't know the new tenant's information, the account will revert back to the landlord)

Name *

Phone *

Email *

Mailing Address *

**If different from service address**

Bank Information

Bank Name *

Bank Routing Number *

Bank Account Number *

Void Check *

**If you are signing up for auto pay, you must attach a copy of a voided check so that the Utility team can verify the information entered is correct.**
Files must be less than 2 MB.
Allowed file types: jpg jpeg pdf.

Moving Out

Information for PREVIOUS responsible customer (Please enter N/A in all fields if unknown.)

Name *

Forwarding Address *

**For Final Bill**

Was this account on auto payment? *

Yes

Unknown

Signature *

Typing your name here constitutes a signature

Date

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Residential Application / Termination Form

Contact Information