Short Term Services should not exceed 180 days. Please let us know if the service term will exceed this time limitation as a service deposit will be required. Upon completing this form, you will be billed a $25.00 non-refundable activation fee. You will be billed monthly for all water usage while the 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 $50 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: (required)

City

US States (Select State)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Company Name

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Account Number (If you are a new customer please leave this field blank. If you are an existing customer please include your account number to help expedite this process.)

DCWA Account Number

First Name (required)

Last Name (required)

Billing Address (required)

City (required)

US States (required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip (required)

Phone (required)

Email (required)

FEIN or Social (Please enter your Federal Employer ID Number, or your personal Social Security Number) (required)

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 4 pm on your selected date. Your presence is not required. However, 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.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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