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2. Name*
   Enter the first and last name of the account holder.
4. Service Address*
   Enter the address where you want to sign up for water or sewer service.
5. ZIP Code*
   Enter the 6 or 8 digit ZIP Code for your service address.
7. Own or Rent or Land Contract*

   1. Own
   2. Rent
   3. Land Contract
8. Move-in Date*
   Move-in Date
   Select the date you will become responsible for the water/sewer bill
10. Mailing Address*
    Type either "Same as Above", or the address where bills should be mailed to (street address, city, state, and zip).
12. Email Address*
13. Home Phone Number
14. Cell Phone Number
16. Preferred Contact Method
    Indicate your preferred contact method.
18. Sign-up for paperless billing?*

    1. Yes, sign me up for paperless billing
    2. No, decline paperless billing
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field