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Water/Sewer Application

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