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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 Number*
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 Number
43. Date to Activate Service*
    Date to Activate Service
45. 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.
46. Payment Information
    View Payment Terms and Options
48. Fees
    Deposit: $45 (Refundable Following Cancellation) Set up Fee: $25 Total Due: $70

50. Application, deposit, and valid identification are all required at the time of request. A Customer Service Representative will contact you within 24 business hours regarding the $70.00 fee.

52. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
54. Electronic Signature
Leave This Blank:


56. Submit

* indicates a required field