Application for Water, Sewer and Trash Service

2. 

4. Application Date*
   Application Date

5. Service to begin*
   Service to begin

6. Applicant*

   1. Owner
   2. Tenant - $200. Security Deposit required with application

8. Service Address*

10. Mailing Address, State & Zip (if different from service address)

14. Applicant Name*

15. Email Address

17. Driver's License or ID #*

18. Last 4 digits of SSN #*

20. Your preferred phone number will be used to contact you in the event of a service interruption, non-emergency matter, or billing issue.

    Your preferred phone number will be used to contact you in the event of a service interruption, non-emergency matter, or billing issue.

21. Preferred Phone Number*
    -- Select One --CellHomeWork

22. Phone number with area code*

25. Additional Phone Number
    -- Select One --CellHomeWork

26. Phone number with area code

28. Applicant # 1 Signature

32. Applicant Name # 2

33. Email Address

35. Driver's License or ID #

36. Last 4 digits of SSN #

38. Phone Number, for Applicant #2

39. Preferred Phone Number
    -- Select One --CellHomeWork

40. Phone number with area code

43. Additional Phone Number
    -- Select One --CellHomeWork

44. Phone number with area code

46. Applicant # 2 Signature

50. Utility Billing and Collections – A $10. application fee will appear on your first Utility Bill. Bills are due the on last business day of the month. If payment is not received by the 1st of the following month, a 10% late fee will be added. If the bill is not paid within 35 days, service will be terminated. There is a $50. reconnect fee.

52. The $10. application fee will be waived, if the utility account was previously in your name.

53. Previous Cranberry Township address

57. Save $1. per month with E-bill and Auto Debit

59. Bank Name

60. Bank Account #

61. Routing #

Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field