Commercial Application / Termination Form

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Business Service Address *

Account # *

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

Landlord/Owner *

Is this an ownership change? *

Yes

Date to Read Meter

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

Information for New Business

Name of Business *

Nature of Business *

FEIN *

Business Phone *

Information for NEW Responsible Customers/Owner

Applicant's Name *

Phone Number *

Email Address *

Mailing Address *

If different from service address

Information for PREVIOUS Responsible Customer

Name/Forwarding Address for Final Bill *

Signature *

Typing your name here, constitutes as a s signature

Date

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Commercial Application / Termination Form

Contact Information