Application for Residential Service - Limestone County Water

Today's Date *

Requested Date of Service *NOTE: You must pay your new service fee before 10AM on the day you are wanting service on. Please note that the LCWSA office must have time to process your application after it is submitted before you can make payment. Therefore, we request your application be filled out two business days prior to the day you need service. Applications should not be filled out more than two weeks ahead of your requested date of service.

You… *own the propertyare renting the propertyare managing the property

Closing Date *

Last Name (or if putting in your business name, please enter business name in both the Last Name and First Name fields) *

First Name *

I would like to add a spouse/co-applicant to the account.

Business Name *

Tax ID *

Co-Applicant's Last Name *

Co-Applicant's First Name *

Service Address

Service Address *

City *

State *

Zip Code *

Is there existing water service at this address (a water meter is already present)? *YesNo, I need a new tap

All tap requests must be approved through our engineering department. Please allow us 2-3 business days to approve the request. After it has been approved and the account has been created, we will notify you.

Please specify the size meter you need (if you are unsure, please check with your builder): *3/4″ (standard size): $1,5001″: $2,000

Is your mailing address different from the service address? *YesNoBills will be mailed to you monthly. Bills will also be sent to the email address provided on the application.

Mailing Address

Mailing Address *

City *

State *

Zip Code *

Personal and Contact Information

Phone Number *

Alternate Phone Number

Email Address *Bills will be sent monthly as e-bills to this email address. They will also be sent as paper bills to the mailing address provided on this application.

Property Owner's Last Name *

Property Owner's First Name *

Property Owner's Phone Number *

Driver's License Number *

Social Security Number (or Tax ID if putting in business name) *If you do not wish to submit your Social Security Number with your form, you must visit the LCWSA office.

Photo of Driver's License (attach file)

No file chosen

File upload size limit: 13 MB. Your account will not be complete until you have either attached your driver’s license photo here or emailed it to customerservice@lcwsa.com.

Co-Applicant's Driver's License Number *

Co-Applicant's Social Security Number *If you do not wish to submit your Social Security Number with your form, you must visit the LCWSA office.

Photo of Co-Applicant's Driver's License (attach file)

No file chosen

File upload size limit: 13 MB. We must have a copy of the co-applicant’s license in order to add them to the account. It can be attached here, combined in the same file as the applicant’s license, or emailed to customerservice@lcwsa.com.

Landlord's Name *

Landlord's Phone Number *

Landlord's Mailing Address *

City *

State *

Zip Code *

Copy of Lease Agreement (attach file)

File upload size limit: 13 MB per file. If renting, you must provide a formal lease agreement (both the front page and the signature page). If it is informal, it must be notarized. Your account will not be complete until you have either uploaded your lease agreement here or emailed it to customerservice@lcwsa.com.

Have you had service with Limestone County Water before? *YesNo

List the addresses where you have had service with us: *

Disconnecting Service

**If you need to disconnect service at a property, please fill out our disconnect form after completing this form.**

Pease click to read our Terms and Conditions.

I/we accept the above terms and conditions.

I understand that I must pay my new service fee before 10AM on the day I need service on. I understand that the LCWSA office must have time to process my application after it is sumbitted before I can make payment and that they will reach out to me via phone and/or email after my application has been processed. I understand that if I do not submit payment before 10AM on the day I need service, I may be subject to additional fees and/or wait time.