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)

Applicant Name (Individual or Business Name) (required)

Date of Birth (required)

Are You a U.S. Military Veteran?

Yes

Employer (required)

Driver License Number (required)

Driver License Expiration (required)

Phone Number (required)

Additional Phone Number (optional)

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?

Certification - Please type your name in lieu of a signature. "By signing I certify that the information provided is complete and accurate, and that I agree to comply with the current Rules and Regulations of Green Area Water & Sanitary Authority related to utility services provided by the Authority." In addition, the Authority will need proof of identity through providing a SSN and driver license or state ID. In addition, the customer will have to provide a signature or e-signature to certify their application. Authority staff will contact the customer to coordinate the receipt of this information. (required)

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