Set up/Terminate Water and/or Sewer Service Request

What Would You Like to Do? (required)

Start service

Stop service

Start/Stop Service Date (required)

Customer Type (required)

Applicant Type (required)

Co-Applicant

Check here only if you are adding yourself as a co-applicant to an existing account. (Note: GAWSA will verify with the current account holder before adding you to the account.)

Applicant Name (Individual or Business Name) (required)

Date of Birth (required)

Are You a U.S. Military Veteran?

Yes

No

Employer (required)

Driver License Number (required)

Driver License Expiration (required)

Phone Number (required)

Additional Phone Number (optional)

Email

By providing my email address, I agree to receive future communications from GAWSA.

Yes

No

How would you like to receive your statement? (required)

Email

Mail

Email AND Mail

Emergency Contact Name (required)

Emergency Contact Phone (required)

Service Street Address (required)

Mailing Address (if different from service address OR for final bill)

Mailing Address City

Mailing Address State

Mailing Address Zip Code

Comments/Questions?

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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