Address for the new water/sewer account
Date you want your water/sewer service account to start
Please provide property owners name/contact information.
Please provide the property owner's mailing address, email address and phone number. Owner will need to sign the form if the property is rented.
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.
When form is completed please print and bring to the Town Office with a current photo ID, Social Security number and a check for the $35.00 Administrative Fee.
Please call the Town Office at (540) 687-5152 if renting to find out additional steps needed to apply and deposit amounts required.
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