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2. Please read and agree to the following statements before electronically signing your request
4. • Approval requirements include: The letter must be from a utility provider established on company letterhead indicating twelve consecutive months of good account status (i.e. no disconnections, late payments, late fees, late notices, or returned checks).
   • Account must reflect active dates within the last 12 months.
   • The person referenced in the letter of credit must match the name of the person who establishes the water account, our office must receive this letter within 30 days after the service start date.
6. Notice regarding electronic signature

   Pursuant to the North Carolina Uniform Electronic Transactions Act, digital application documents are legally binding in the same manner as are hard copy documents executed by hand signature. The applicant hereby consents to the use of electronic or digitized signatures or scanned copies of original signatures, and the applicant intends to be bound by the application and any related documents.

   By submitting an application with an electronic or digitized signature or a scanned copy of the original application, you acknowledge, agree, and authorize your electronic or digitized signature or your scanned original signature to be valid and binding upon you in the same manner as are hard copy documents executed by hand signature.

8. Water Account Number*
10. First Name*
11. Middle Initial
12. Last Name*
13. Suffix
15. Phone Number*
16. Type of Phone Number:*
    -- Select One --CellHomeWork
17. Email Address*
19. Service Location Address*
20. Suite or Apt#
22. Description
24. Attach Additional Documents*
25. Attach Additional Documents
26. Attach Additional Documents
28. "Sign" your application by typing your name below:*
29. Date:*
    Date:
Leave This Blank:


31. Submit

* indicates a required field