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2. Applying For
   -- Select One --Start of ServiceChange of Service
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. Mailing 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. Social Security Number/Tax ID Number**
37. Driver's License Number*
38. Upload Driver's License*
40. Additional Authorized User
41. Authorized User Phone
43. Date to Activate Service*
    Date to Activate Service
    24 business hours required to request activation. Town Hall Customer Service hours are 8 a.m. to 5 p.m., Monday through Friday. Contact Customer Service at 704-455-5614.
44. Payment Information
    View Payment Terms and Options
46. Fees

    Deposit: $45 (Refundable Following Cancellation)

    Set up Fee: $30

    Total Due: $75

    
    

    Completed application, deposit, and valid identification are all required at the time of request.

48. 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.
50. Initials*
Leave This Blank:


52. Submit

* indicates a required field