Upon completion of this form, you will be billed a $25.00 non-refundable activation fee. You will be billed monthly for all water usage while service is in your name. If you do not receive your bill, contact our office. All bills are due and payable when rendered. Service will be disconnected if payment is not received by the 10th day of the month. A $25.00 delinquent fee will be charged once disconnected. All scheduled services will be completed by 5:00 PM on the date requested. Same day service fees are $25.00, and after-hour fees are $50.00. Charges will be applied to your account accordingly. 

Service Address

City

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Zip

Company Name

Account Number

First Name

Last Name

Billing Address

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip

Phone

Email

FEIN/ID#

Requested Start Date

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Acknowledgment: By Submitting this form you acknowledge that the water will be turned on between 7 am and 3 pm on your selected date. If you or your representative cannot be present for the service to be turned on you assume full responsibility for any water damage to the home. You will be charged a $25 non-refundable activation fee to start service in your name.

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Digital Signature statement: I understand that my electronic signature binds me to the terms of this Application the same and as effectively as if I signed the application with my handwritten signature. I agree to conduct business with Dorchester County Water Authority (DCWA) through my electronic or digital signature, and I confirm that DCWA may rely on my electronic signature.

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Confirm e-Signature

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Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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