Kenansville Application for Water/Sewer Service

Date Date / MM / DD YYYY
Number in Household/Employees
Customer Name
Customer Name (Spouse)
Date Service Needed Date Service Needed / MM / DD YYYY
Social Security Number/EIN
Driver's License Number
Service Address Service Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Billing Address Billing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Previous Address Previous Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Is plumbing complete/repaired and ready for water to be turned on?

Is plumbing complete/repaired and ready for water to be turned on? Yes No
Note:

We prefer that someone be on the premises when service is turned on in case there are any broken lines or faucets left open. If there is an indication that there is water on (over 10 gallons runs through meter) service will not be connected. A service call will be charged to return and connect service.
Place of Employment/Business
Work Phone Work Phone - ### - ### ####
Spouse's Place Of Employment
Spouse's Work Phone Spouse's Work Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
I hereby apply for utility service (water and/or sewer, if available) and solid waste recyclables collection at the address shown above, and agree to abide by the rules and regulations governing such service as ordained by the Town Board of Commissioners of the Town of Kenansville.
Property Owner/Business Owner/ Lessee - Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Kenansville Application for Water/Sewer Service

Note: