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Residential Water Service Application

This form has been modified since it was saved. Please review all fields before submitting.

Address*
Apt #
Mailing address
City
State
Zip
Start Date
First Name*
Last Name*
driver's license/id*
date of birth*
phone number*
email address
Place of employment and phone number
co-applicant's first name
co-applicant's last name
co-applicant's driver's license/id
co-applicant's date of birth
co-applicant's phone number
co-applicant's email address
co-applicant's place of employment and phone number
Landlord's name
Landlord's phone number
Account Confidentiality*
1. yes
2. no
By submitting this application, you agree to the terms and conditions of city ordinance code 51.037.