Please Note

The federal Red Flag Rule was passed on November 1, 2008. The law states that customer service is only allowed to speak with people listed on the account and only after verifying personal information.

Contact Information

First Name:*

Last Name:*

Email:

Cell Phone:*

Work Phone:

Service Address:*

Mailing Address:

City:*

State:*

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Zip:*

Drivers License Number:*

Social Security Number (last 4 digits only):*

Date of Birth:*

Tax ID No.

Spouse/Secondary Information

Name:*

Driver's License Number:*

Social Security Number (last 4 digits only):*

Date of Birth:*

Transfer Account Information

Previous Address:*

Date of Disconnect:*

New Address:*

Date of Connect:*

Residential Phone:*

Cell Phone:*

Property Status*

Own

Rent

Pool*

Yes

No

Sprinkler System*

Yes

No

Confidentiality

I request that all account information be kept confidential

Permission

Business Accounts Only: I grant permission for utility billing to speak to any current staff member upon verifciation of Tax ID number regarding the service address listed above.

I understand that the City will begin water service by making a physical connection located at the meter outside the building or buildings to be served. I understand that the City will not have access to any building served and will not determine if there are any open faucets or water system leaks inside the building. I understand that I am responsible for services provided by the City as charged on my monthly bill. I understand that I am responsible for late fees, reconnect fees, and any charges incurred in accordance with City Ordinance(s). I understand and agree to abide by the service agreement provided by the utility billing
department.