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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*
15. Last Name*
17. Service Address*
19. City*
20. State*
21. Zip Code*
23. Forwarding Address*
25. City*
26. State*
27. Zip Code*
29. Phone*
30. Enroll in Text Alerts

    1. Yes
    2. No
32. Email
33. Enroll in Electronic Billing

    1. Yes
    2. No
35. Additional Authorized User
36. Authorized User Phone
38. 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.
39. Payment Information
    View Payment Terms and Options
41. 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.
43. Initials*
Leave This Blank:


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

    This field is not part of the form submission.

47. Submit

* indicates a required field