Establishing Service with the City of Canton

Please note that the City of Canton Water Department will contact you within 1 (one) business day after receipt of this request. Your service will be connected within 2-3 business days of completed application and application. In the event you have any question feel free to contact us at 770-704-1502.

Start Service Date * +

Customer Type: *

Service(s) Requested:

Sewer	Water
Irrigation

What is the service address for the services you are requesting. *

First Name *

Last Name *

Customer Name #2 (If Different From Above)

Phone Number *

Cell Phone Number

Email Address *

Enroll me in e-mail notifications

Yes

No

Enroll me in Text notification (must provide Cell number)

Yes

No

Do you have, or have you ever had, service with us before? *

If yes, please list all addresses which you currently have, or previously had, service:

Do you need to stop service at any of the above listed addresses? *

Service Address that needs to be deactivated:

Date to stop service: +

Mailing Address

First Name *

Last Name *

Business Name

Street Address *

City *

State *

Zip Code *

Phone Number *

If you are renting the home

Homeowners First Name

Homeowners Last Name

Homeowner Phone Number

Homeowner Email Address

By digitally signing below I agree that I am responsible for utility bills for service dates after the above-listed request date for service to start. I understand that if I am the owner of the property I will be responsible for paying the $

35.00 service fee

($50 if the Irrigation service)

. If I am the renter or landlord of the property I understand that I am required to pay a deposit of $125.00,

and a service fee of $35.00 ($50 if the irrigation service)

payment will be due at the time I apply for service. This is a security deposit that will be applied to the final bill when the account is closed. Please note that the security deposit will NOT be refunded until the account is closed. I give the City of Canton permission to establish a utility service in my name.

If you are an owner, you must attach a copy of your HUD Settlement Statement, deed, purchase agreement, or closing documentation, and a valid ID or Drivers License. If you are a renter, you must attach a signed copy of your lease and a valid ID for the occupant requesting service. If you are a commercial account please provide proof of ownership or management agreement, and a W-9 or business license for the company name. *

*

Type Your Name *

Drivers License # or State ID # *

Drivers License State *