New Water Service Application

1Primary Account Holder Information

2Secondary Account Holder Information

3Contact Information

What type of service are you applying for?*
- Residential
- Commercial
Name of Business?*
Name:*
First Last
Do you currently have an account with us?*
- Yes
- No
What is your current address?*
New Service Address:*
Billing Address*
Do you rent or own the property where you are applying for service?*
- Own
- Rent / Lease
Landlord Name:*
Date for Start of Service:*
MM slash DD slash YYYY

we cannot start service more than 7 days in advance
Tax ID Number?*
Social Security Number:*
Driver's License or ID Number*
Drivers License State*
Date of Birth*
MM slash DD slash YYYY

You must be at least 18 years old to start new water service in your name.
Phone Number*
Email*
Enter Email Confirm Email
Emergency Contact Name*
First Last
Emergency Contact Phone Number:*
Place of Employment*
if unemployed, student, or retired please designate
Please upload the following documents:

1) Your ID (Your driver’s license is preferred. If you do not have a driver’s license, please submit a copy of your state ID, passport or other legal identification.)
2) RENTAL PROPERTY: Please submit a copy of the first page of your lease with the landlord’s name, the tenant’s name(s), and the address along with a copy of the signature page.
PURCHASING: if you are buying your home, please submit a copy of your Real Estate Purchase Agreement. Note: if you have questions about what you need to submit, please call (620) 231-4100 for assistance.
Please upload the following documents:

1) Tax ID
2) RENTAL PROPERTY: Please submit a copy of the first page of your lease with the landlord’s name, the tenant’s name(s), and the address along with a copy of the signature page.
PURCHASING: if you are buying your property, please submit a copy of your Real Estate Purchase Agreement. Note: if you have questions about what you need to submit, please call (620) 231-4100 for assistance.
Please remember to click the blue upload button above this before proceeding to the next step.
Note: We are asking you fill in the fields above again for additional security verification.

Is there a secondary Account Holder?*
- Yes
- No
Name
First Middle Last
Social Security Number
Drivers License or ID Number
Date of Birth
MM slash DD slash YYYY
Place of Employment
if unemployed, student, or retired please designate
Phone Number
Email
Enter Email Confirm Email
Please upload the following documents:

Your ID (Your driver’s license is preferred. If you do not have a driver’s license, please submit a copy of your state ID, passport or other legal identification.)
Please remember to click the blue upload button above this before proceeding to the next step.
Note: We are asking you fill in the fields above again for additional security verification.

Based on your application, you have selected that you are renting or leasing this property. A security deposit is required. For your convenience, you may choose to pay for your new Water Service Deposit online (shown below) or you may call (620) 231-4100 and talk with one of our Customer Service Specialists during normal business hours.
Based on your application, you have selected that you are renting or leasing this property and are currently renting in the City of Pittsburg. Our Customer Service Specialists will review your current account and call you at the number you provided within 24 to 48 hours.
YOUR APPLICATION ISN'T COMPLETE UNTIL YOU CLICK THE GREEN BUTTON BELOW

Based on your application you have selected that you own this property. A security deposit is not required. If you have any questions you may call (620) 231-4100 and talk with one of our Customer Service Specialists during normal business hours.

A connection fee is required if the water service is currently disconnected. If this is necessary there will be a fee added to your first months bill. The current fees are
- Inside City Limits is a one time fee of $10
- Outside City limits is a one time fee of $20
Where is the property located?*
- Inside the City Limits
- Outside the City Limits
Telephone Number where we can reach you?
Preferred method of contact?
- Phone Call
- Email
Preferred Time of Day to reach you?
- 8:00 am -10:00 am
- 10:00 am - 2:00 pm
- 2:00 pm - 4:00 pm
Name
This field is for validation purposes and should be left unchanged.

Related Links

New Water Service Application

Contact Information