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)Owner Tenant Landlord/Property Management Applicant Type (required)Individual Business/Organization/Other Co-ApplicantCheck 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? By applying for service, I agree to provide the Authority my social security number or tax ID number prior to starting service and will allow Authority staff to contact me for receipt of this information. 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 There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
