Water Service Application

This Application is for:*
- Residential Service
- Commercial Service
- Irrigation
Name*
First Last
Email
Phone*
Social Security Number*

Service Address*
Please enter the address for which you are applying for service.

Street Address Address Line 2 City State ZIP Code
Is your Mailing Address different than the Service Address?*
- Yes
- No
Mailing Address
Street Address Address Line 2 City State ZIP Code

Spouse/Roommate Name
First Last
Spouse/Roommate Social Security Number
Spouse/Roommate Employer
Spouse/Roommate Employer Address
Street Address Address Line 2 City State ZIP Code
Name of All Other Residents (Living in the House)*

Any Previous Service Location
Street Address Address Line 2 City State ZIP Code
How long did you have service at this location?
Is this property being rented?*
- Yes
- No
Landlord's Name
Landlord's Address
Street Address Address Line 2 City State ZIP Code
Water Policies*
By checking this box, I acknowledge that I have received, read, and understand a copy of the City of Swainsboro Water Policies. I also acknowledge responsibility for above account and activity associated with above account.
Type of Service Requested*
- Water
- Sewer
- Other
If other, please specify:

Federal Compliance