ONLINE APPLICATION FOR NEW SERVICE

**Please note, this is for transferring of accounts, new meter purchase has to be made in person at our office.

Instructions: Please fill out the online application for new service, make sure you read and understand the “terms of agreement”. Please make sure all information is filled out correctly, then click submit. Please note that applications will NOT be accepted or water service will NOT be turned on without all requested information. Once we receive your application, please allow 24 hours for us to process. Once the application is processed, a customer service clerk will contact you with a deposit amount and any other associated fees. Both amounts are DUE at that time or the service application will be denied.

Today's Date: *

Month/Day/Year

Date of Service Requested: *

Month/Day/Year

Service Address applying for: *
Are you buying this location
or are you renting this location?
             *
If you are renting this location,
please list the owners name:
 
 
Applicants Name: *
Billing address: *
Primary Phone: *
Secondary Phone:
Email Address: *
Date of Birth: *

Month/Day/Year

Social Security Number: *
Driver's License Number: *
Employer (If employed):
Employer Phone:
Emergency Contact Name: *
Emergency Contact Phone: *
Have you ever been an
Etowah Water customer?
                *
Does your location also
require sewer service?
                *

Terms of Agreement:

The applicant agrees to the following: I agree to pay the minimum bill per month and for all water/sewer consumed. When my property is sold, the meter installed on the property will be included in the sale. I will notify Etowah Water & Sewer Authority the day that I request for a final read. I will also be solely responsible for this or any transfers on the account. A deposit is required once the application has been approved. Please note that if you are a renter or you lease a location, you may have to provide a copy of your rent/lease agreement. There will also be a $10.00 new service fee for all customers transferring service into their name. *If sewer service is at this location, the sewer deposit will be equal to the water deposit.

After the applicant has vacated the premises and the final bill has been paid in full, the deposit will be refunded. If a new contract is not received within 48 hours of the date of transfer, service will be disconnected and a $75.00 reconnection fee charged. The applicant also agrees if the service applied for is in an area with water pressure adequate for domestic usage, but is low for the use of dish washers, washing machines and other automatic equipment then the applicant will provide and maintain their own booster pumping system as a condition of this service. Service will be established after the application is processed, deposit has been made, and all other necessary information has been provided and approved by our office. If the meter has been locked or pulled for any reason, our office will notify you and make arrangements for the water to be reconnected. Customers must insure all inside plumbing is shut off. Any damage as a result of open faucets or leaks inside the residence is the customer’s responsibility. Only authorized personnel are allowed inside the meter box. If someone other than an Etowah Water and Sewer Authority employee damages the meter box or its contents, the customer of record will be held responsible. Any maintenance, turn on, turn off, or re-reads will be done per customers request or during regular maintenance and reading schedules. Duly authorized agents of the Authority shall have access at all hours to the premises of the consumer for the purpose of installing or removing Authority property, inspecting piping, reading and testing meters, or for any other purpose in connection with the water service and its facilities.The applicant understands that it is a violation of state law to obtain water or sewer services without paying for them and that it is further a violation to destroy, damage, deface, or otherwise tamper with water or sewer infrastructure, including meters or any piping associated therewith. The applicant further understands that if it is determined by the Authority that there has been unauthorized use, misuse, theft, destruction, damage, defacement or tampering with water or sewer infrastructure owned by the Authority, the applicant or any resident user can and will be required to pay the Authority liquidated damages ranging from $1000 to $5000 (1st violation $1000; 2nd $2500; 3rd $5000), may have service disconnected and be required to pay a service reconnection fee and an additional deposit.

Applicants are responsible for all billing charges until applicant has requested service to be terminated in his/her name. Failure to receive a bill does not entitle delayed payment. If this bill is not paid, an automatic 10% late fee will be added to the balance owed. If we do not receive your bill before the disconnection date, your service will be disconnected and the applicant will be charged a 75.00 reconnect fee. “The applicant understands that any credit granted shall be paid promptly in accordance with terms and agreement; in the event of default, the undersigned agrees to pay reasonable collection charges, court costs and attorney fees.”

***By clicking "Submit", you are accepting the Terms of Agreement***