Application for Residential Service - Limestone County Water

Today's Date *

Requested Date of Service **WE DO NOT OFFER SAME-DAY SERVICE. Please apply at least two business days before your requested date of service. If you need service sooner, please come to our office to apply. Your service turn-on date is subject to change based on your closing date, necessary documents being submitted, etc.

You… *own the propertyare renting the propertyare managing the property

Closing Date *

Last Name (or if putting in your business name, please enter business name in both the Last Name and First Name fields) *

First Name *

I would like to add a spouse/co-applicant to the account.

Business Name *

Tax ID *

Co-Applicant's Last Name *

Co-Applicant's First Name *

Service Address

Service Address *

City *

State *

Zip Code *

Is there existing water service at this address (a water meter is already present)? *YesNo, I need a new tap

All tap requests must be approved through our engineering department. Please allow us at least 2-3 business days to process the request and get back with you.

Please specify the size meter you need (if you are unsure, please check with your builder): *3/4″ (standard size): $1,5001″: $2,000

Is your mailing address different from the service address? *YesNo

Mailing Address

Mailing Address *

City *

State *

Zip Code *

Personal and Contact Information

Phone Number *

Alternate Phone Number

Email Address *

How would you like to receive your bills each month? *Paper BillE-Bill

Property Owner's Last Name *

Property Owner's First Name *

Property Owner's Phone Number *

Driver's License Number *

Social Security Number (or Tax ID if putting in business name) *If you do not wish to submit your Social Security Number with your form, you must visit the LCWSA office.

Photo of Driver's License (attach file)

No file chosen

File upload size limit: 13 MB. Your account will not be complete until you have either attached your driver’s license photo here or emailed it to newaccounts@lcwsa.com.

Co-Applicant's Driver's License Number *

Co-Applicant's Social Security Number *If you do not wish to submit your Social Security Number with your form, you must visit the LCWSA office.

Photo of Co-Applicant's Driver's License (attach file)

No file chosen

File upload size limit: 13 MB. We must have a copy of the co-applicant’s license in order to add them to the account. It can be attached here, combined in the same file as the applicant’s license, or emailed to newaccounts@lcwsa.com.

Proof of Purchase Documentation

We may require proof of purchase documentation. You can upload it here or email it to newaccounts@lcwsa.com. This should be a legal document with your name and the address (examples include closing disclosure, settlement statement, and sales contract). File size limit: 13 MB.

Landlord's Name *

Landlord's Phone Number *

Landlord's Mailing Address *

City *

State *

Zip Code *

Copy of Lease Agreement (attach file)

File upload size limit: 13 MB per file. If renting, you must provide a formal lease agreement (both the front page and the signature page). If it is informal, it must be notarized. Your account will not be complete until you have either uploaded your lease agreement here or emailed it to newaccounts@lcwsa.com.

Besides you (and your co-applicant if listed), are there any adults (people 18 years or older) who are listed as tenants on your rental agreement? *YesNo

Please list the names and Social Security Numbers of all adult tenants on your rental agreement. This is required in order to start your services. *

Have you had service with Limestone County Water before? *YesNo

List the addresses where you have had service with us: *

Disconnecting Service

**If you need to disconnect service at a property, please fill out our disconnect form after completing this form.**

Please click to read our Terms and Conditions.

I/we accept the above terms and conditions.

I understand that the LCWSA office does not offer same-day service. I understand that service will not be turned on/put in my name until at least one business day after the day I make my new service fee payment. I understand that I cannot make my new service fee payment until the LCWSA office has had time to process my application and send me an email with my account information and payment methods to pay the fee.