Beckley Water Residential Water Sign Up

APPLICATION FOR WATER SERVICE
Customer Sign Up Form
Name
First NameMiddle NameLast Name
Email
example@example.com
Spouse/Other Family Member
Name of Spouse or other person at requested service address
Daytime Phone Number
Format: (000) 000-0000.
Other Phone Number
Format: (000) 000-0000.
Date of Birth
MonthDayYear
SSN (Last 4 digits) or EIN
Drivers License #
Drivers License or Government Issues I.D. Number
State Issued
Government Issued ID
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CUSTOMER SERVICE ADDRESS
Address where you are requesting water service turned on.
Address of Service
Street Address
Street Address Line 2
CityState
Zip Code
Requested Service Date
MonthDayYear
Allow 48hrs after form submission
Is Water Currently On at this Service Location?
Do you know current customer's information at this service address?
Current Customer's Name
First NameLast Name
CUSTOMER MAILING ADDRESS
Address where you are receiving mail and would like your bills sent
Customer Mailing Address
Mailing Address
Street Address
Street Address Line 2
CityState
Zip Code
Wastewater - City or Private
in this next section, choose between which sewer company you have and info related
Do you have City Wastewater or Septic?
Sanitary Sewer (Wastewater)
Sanitary Sewer Account Number
Type in account number including dashes
Sewer Department Receipt
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Upload a scan or clear picture of your receiptCancelof
I understand and agree that selecting this option, my water will be terminated if found to be on City Sewer. Furthermore, I am responsible for any water used, any and all billing amounts accrued during time of service.
Other Documents
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Cancelof
Are you currently a Beckley Water customer? Or have you been a customer before?
If previous Beckley Water customer, please include the following:
Name on Previous Account
Account Number on Previous Account
Service Address on Previous Account
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number Associated with Previous Accounts
Area CodePhone Number
Your deposit to Beckley Water Company needs to be paid before getting water turned on.
Applicant's Signature
Clear
Autocompleted Address
Address Map Locator
Should be Empty:

APPLICATION FOR WATER SERVICE

CUSTOMER SERVICE ADDRESS

CUSTOMER MAILING ADDRESS

Wastewater - City or Private

If previous Beckley Water customer, please include the following: