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2. Applying For
   -- Select One --Cancellation
4. Category of Service
   -- Select One --ResidentialCommercial
6. Location Type
   -- Select One --Inside Town LimitsOutside Town Limits
8. Applicant Type
   -- Select One --Owner/Property Mgr.RenterBuilder
10. Service Type
    -- Select One --Water/SewerFlat SewerWater OnlyIrrigationStorm Water
12. In order to process your application, we ask you to provide the following information.
14. First Name or Business Name*
15. Last Name or Business Name*
17. Service Address*
19. City*
20. State*
21. Zip Code*
23. Forwarding Address*

    * Please note - All final bills will be sent via mail to the forwarding address provided *

25. City*
26. State*
27. Zip Code*
29. Phone*
30. Enroll in Text Alerts

    1. Yes
    2. No
32. Email
34. Additional Authorized User
35. Authorized User Phone
37. Date to Cancel Service*
    Date to Cancel Service
    24 business hours required to request cancellation. Town Hall Customer Service hours are 8 a.m.to 5 p.m., Monday through Friday. Contact Customer Service at 704-455-5614.
38. Payment Information
    View Payment Terms and Options
40. Confirmation
    Please initial to agree that you verify that the above information is correct and accurate to the best of your knowledge and that you also understand and agree with the content/stipulations listed.
42. Initials*
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field