Request for Water/Sewer Service

Request for Water/Sewer Service

Please fill in the form below in FULL. ALL questions MUST be answered. You will be asked to provide a copy of your identification and lease.
Submissions are processed during normal business hours Mondays through Fridays from 8 am to 5 pm, except holidays. Please allow 1-2 business days for processing.

A $150 deposit is required for residential tenants only. Commercial tenants' deposits begin at $200 and can go up. A nonrefundable service charge of $15 is required for all tenants and owners creating an application for water service. Please make checks payable to: City of Greensboro. Deposits are held until the final bill and are not transferable.
DATE FOR TURN-ON *

Month Day Year
Please allow 1-2 business days after submission for service to start.
ARE YOU THE *

Tenant Owner
NAME TO BILL *

First Name Middle Name Last Name Suffix
SERVICE ADDRESS *
Email *
example@example.com
PHONE NUMBER *
Cell / Home
DATE OF BIRTH *

Month Day Year
Must have a document showing your date of birth.
PHONE NUMBER
Work / Other
DRIVERS LIC / ID NO. & STATE

Drivers License / State Issued ID State
DRIVER'S LICENSE *
Government-issued ID also accepted
STATE *
State that appears on your driver's license
EXPIRATION YEAR
LAST 4 DIGITS OF SOCIAL SECURITY / TAX ID
Accepted: I-9, passport, government issued ID
SPOUSE / CO-TENANT / ADDITIONAL AUTHORIZED USER

First Name Last Name
LAST 4 DIGITS OF SOCIAL SECURITY / TAX ID
Accepted: I-9, passport, government issued ID
Upload copies of your identification. If you are a tenant, a copy of your lease is also preferred.

Cancel of
ADDRESS OF LAST WATER SERVICE

Last address for water service
DATE OF CUT OFF FOR LAST SERVICE

Month Day Year
Date
MAILING ADDRESS (if different from service address)

Street Address

Street Address Line 2

City State

Postal / Zip Code
If you are a Landlord please provide your CIS number to avoid the $15 service fee. To request a CIS number please call 336-373-CITY (2489)
PROPERTY OWNER

NAME

Street Address

City State

Postal / Zip Code
MORTGAGE COMPANY

NAME

Street Address

City State

Postal / Zip Code
If you are a tenant you will need to provide
- 2 forms of ID by mail or in-person
- deposit & service fee (total $165 for residential tenants)
- landlord contact information or a copy of your lease (preferred)
The above information with a copy of this form can be submitted by mail or in-person to the address below.
CHARTER / Chapter VI - CITY SERVICES AND FACILITIES / SUBCHAPTER A. - ESTABLISHMENT AND MAINTENANCE OF SERVICES AND FACILITIES / ARTICLE 7. - WATER SUPPLY, SEWERAGE AND WASTE DISPOSAL AND OTHER UTILITIES / Sec. 6.83. - Liens for utility charges.

(a) Except as provided in subsection (b) of this section, when any charge for utility service or for the use of utility facilities is not paid within ten days after it becomes due, the same shall become a lien upon the property served or in connection with which the service or facility is used. The charge may at any time thereafter be collected, either by suit in the name of the city or by the city tax collector for the city, by the sale of the property upon which the lien attaches at the GuilfordCounty courthouse door, after advertising the sale once a week for four successive weeks in some newspaper published in the city which is qualified to carry legal notices. The sale shall be made under the same rules and regulations, and subject to the same costs and penalties and to the same rights of redemption as are provided by law for the foreclosure of the lien on real estate for taxes.

(b) When any charge for utility service or for the use of utility facilities is for a rental property and the tenants of the rental property are individually liable for the charge, the city shall collect any charge that is incurred and becomes past-due after July 1, 2010, pursuant to the provisions of G.S. 160A-314 and any other applicable general or local law. The city shall not collect any charge from a tenant that is incurred and becomes past-due after July 1, 2010, under the provisions of subsection(a) of this section.
Signature *

Clear
CITY OF GREENSBORO
WATER RESOURCES DEPARTMENT CUSTOMER SERVICE
2602 S-ELM EUGENE STREET, GREENSBORO, NC 27406
PHONE 336-373-CITY (2489) (VOICE)
EMAIL
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