Water/Sewer Service Application

A $50 connection fee applies to accounts without previous Griswold utility service.

For your security, please don't type a Social Security Number into this form. City Hall will collect that from you separately, by phone or in person, once your application is received.

Applicant

NamePhysical address (service address)Mailing address (if different)Phone numberDriver's license #

Have you had service in Griswold before?

YesNo

If yes, previous address of serviceRequested service start date

Co-applicant (if any)

NamePhysical addressPhone number

Landlord (if renting)

Landlord nameLandlord phone number

Reference / employer

EmployerEmployer phone numberReference nameReference phone numberSend my bill by email instead of mailEmail address for billing (if checked above)

Applicant's signature

Type your full legal name to signI certify the information in this application is true and accurate to the best of my knowledge.