2. Please Note
   We cannot accept any applications any further in advance than 5 business days. If you submit any sooner, your application will be rejected.
4. Date Service to Begin*
   Date Service to Begin
5. Time Service to Begin*
   -- Select One --Between 8:00am to 12:00pmBetween 12:00pm to 4:00pmService is already on. No specific time needed.I dont know!
6. Type of Service*
   -- Select One --Residential (You will be living there.)Commercial (Business or Rental Property.)Irrigation (Special meter only used to water plants or animals.)
8. Last Name*
9. First Name*
10. Middle Name*
11. Suffix (Jr/Sr/Etc)
13. Service Street Address*
14. City*
15. State
    NC
16. Zip Code*
18. Date of Birth*
    Date of Birth
    Enter the Date of Birth for the Primary Applicant.
20. Is the service address DIFFERENT than your mailing address?*

    1. Yes
    2. No
21. Business Name*
22. Tax ID Number*
24. Mailing Street Address*
25. Mailing City*
26. Mailing State*
27. Mailing Zip Code*
29. Home Phone Number*
30. Cell Phone Number
31. Work Phone Number
32. Extension if Applicable
34. Employer*
35. Email Address*
36. For Residential Customers, please be aware you will have to provide us with a lease or purchase agreement and a copy of a state or federally issued photo ID. For Commercial Customers you will have to provide the articles of Incorporation or a business license that states your Tax ID Number.
38. Lease or Purchase Agreement *
39. Photo ID*
40. Are there any other occupants over the age of 18*

    1. Yes
    2. No
41. If there are other occupants please list their full names*
43. Person(s) Over 18 Phone Number(s)
    Enter phone number for each occupant over the age of 18.
46. Attention!
    You will still be required to provide your Social Security Number and those of any additional occupants prior to establishing any water service.
48. 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.
50. Electronic Signature
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field