Application for Water Service - Ottumwa Water Works

Application for Service

Ottumwa Water Works · 230 Turner Drive · P.O. Box 20 · Ottumwa, IA 52501
Welcome to the online application for service form for the Ottumwa Water Works. Before you begin, please ensure you have the following information available:
- Driver's License #
- Photo ID
Once you have completed the form, a $175 deposit is required to begin service. Payment can be made by dropping off a check at the Water Works blue dropbox or via mail to P.O. Box 20, Ottumwa, IA 52501.

If you have any questions as you complete this application, please call the Water Works office at (641) 684-4606.
Customer Information
Customer Name *

First Name Last Name
Customer Social Security Number *
Businesses: If you do not have a social security number, please contact our office at (641) 684-4606.
Customer Date of Birth *

Month Day Year
Customer Employer *
Account Type *

Single Joint
Joint Customer Information

if applicable
Joint Customer Name

First Name Last Name
Joint Customer Social Security Number
Joint Customer Date of Birth

Month Day Year

Phone Numbers
Customer Phone Number *
Please enter a valid phone number.
Joint Customer Phone Number
Please enter a valid phone number.
Would you like to be added to "Wapello Ready" alerts?

Yes No
Driver's License Information
Customer Driver's License # *
Joint Customer's Driver's License #
Main Customer Photo ID

If you are unable to upload a photo ID, please e-mail a copy to customerserviceoww@gmail.com.
Cancel of

Agreement and Signatures
The applicant agrees that any falsification of the above named account, in order to AVOID PAST BILLS, WILL RESULT IN TERMINATION OF SERVICE.

The customer's deposit will be refunded after all bills have been paid. As part of this contract, Water Works Rules must be complied with at all times. Applicant agrees to pay gross amount after due date. That includes 5% penalty to water purchases.
Customer Signature *

Clear
Joint Customer Signature

Clear
Date *

Month Day Year
Date
Should be Empty:

Application for Service