Water Account Information Form

Utility Account Number

Enter Utility Account number.

Name*

Enter the name on the Utility Account.

First Last

Address*

Enter the address Utility service is provided.

Street Address City State

Phone*

Enter contact phone number for Utility account.

Email

Enter email address for contact person. (Optional)

Year Home was Built*

Enter the year the home was built.

Type of pipe ran from water meter to your house.*

Select the type of pipe ran from the water meter to your house. Please select one.