Water/Sewer Application for Service

Complete the following application if you are a new resident needing water/sewer service inside city limits. There is a service charge that is non-refundable and non-transferable. The fee is $50.00 for homeowners and $100 for renters. You must attach a copy of your driver's license below in order for your application to be completed. Once the form is received, someone will contact you for payment. Your application must be submitted in full with accurate information. If you have any questions, please contact the water department at (615)792-7211.

YOU MUST SUBMIT A COPY OF YOUR DRIVERS LICENSE AS DESCRIBED ABOVE IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED

Account Owner:

Service Address:

The address you need service for.

Service Start Date:

Are you Buying or Renting?:

If You Are Renting, Who Are Your Renting From?

Mail Bills to this Address:

The address you want the bill mailed to.

Phone Number:

Email Address:

Birthdate:

Business Tax ID Number:

For Business Accounts Only.

Driver's License Number:

You Must Submit a Copy of Your Driver's License or Government Issued ID. Please Attach Copy Below.

Attachments

Maximum 4 files.
256 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods jpeg jpg.

Applicant's Next of Kin- Name, Phone #, and Address:

Security Question:

Create a Question That We Can Ask To Identify You. Used To Update and Change Account Information. (Examples: Pets Name, Mothers Maiden Name, High School Mascot.)

Security Question Answer:

Signature:

By Typing Your Full Name You Agree That All The Information Above is Accurate and Agree to The Rules and Regulations of The Town of Ashland City's Water Department.

Today's Date:

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