Renter Service Application

Request For Renter Service Application

Please complete the following form. If you need assistance or have questions, please contact us at 251-968-6323. Complete instructions and a list of required documents for a Renter to Set Up Water Service may be found here. Please check your spam/junk folder if you do not see an invitation email from us in your inbox after two business days.

This is a Four Step Process.
1	Fill out the form and include the required documents.
2	A staff member will verify your information and documents. (usually one business day)
3	An invitation to sign the document will be sent to your email address after the verification.
4	After you receive the invite, review the document and sign.

Issue Date

Effective Date

Name

First

Last

Phone 1

Phone 2

Lease Start Date

Landlord's Name

Service Address

Billing Address Information

Address Line 1

City

State

Zip Code

Drivers License

State Issued

Social Security Number or FEIN

COPY OF LEASE (or Permission Document showing your Name, Unit# & Lease Start Date)

Drag & Drop Files, Choose Files to Upload

COPY OF DRIVER’S LICENSE

Drag & Drop Files, Choose Files to Upload