Application for Residential Service - Limestone County Water

Today's Date *

Requested Date of Service *NOTICE: We require one business day’s notice to start your service. If needing same-day service, we must have received and processed your application and received your new service fee payment by 10:00 AM.

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 2-3 business days to approve the request. After it has been approved and the account has been created, we will notify 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

Mailing Address (if different from service address):

Mailing Address

City

State

Zip Code

Personal and Contact Information

Phone Number *

Alternate Phone Number

Email Address *

Do you prefer email or paper bills? *EmailPaperBoth

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 customerservice@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 customerservice@lcwsa.com.

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 customerservice@lcwsa.com.

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.