Application for Water Service Form | The York Water Company

Effective Date
Effective Date for Water Service to Begin

Your Name & Contact Information

Type of Customer * REQUIRED

Email Address Phone Number Work Phone Fax Number

Property Information for Requested Water Service

Type of Property Property Address City State Zip Code

Would you like a 3^rd party to be notified if your bill is past due? Class of Customer Water used in heating?

Previously a Customer?
Were you previously a customer?

Your Mailing Address for the Monthly Invoice
Mailing Address
(where you prefer to receive your invoice for water service, if different from the service address) City State Zip Code

Customer is which of the following?
RENTER, LANDLORD, or OWNER?

Sewer service must remain in the name of the deeded property owner.

Are you paying for another apartment/unit's water use? If Yes, enter Number of Units and Landlord info:

Landlord's Name Landlord' Address City State Zip Code Phone Number

Sewer service must remain in the name of the deeded property owner.

Number of Units:

Tenant's Name Address City State Zip Code

Enroll in the Timely Automatic Payment (TAP) System
With the TAP System you will continue to receive a monthly water statement. A copy of your water bill will arrive well before the payment is due. Then, if you have any questions, you will have sufficient time to contact us for clarification. We will print a message on your bill when you are enrolled. On the Due Date, we will deduct the Amount Due from your bank account.

Enroll in TAP System (Water Customers)?

Enroll in TAP System (Wastewater Customers)?

Paperless Billing
Save paper! Reduce clutter! Receive you water bill on-line with paperless billing!

Enroll in Paperless Billing?

Comments

I / We request water service to the property entered above. * REQUIRED I / we agree to pay and to use the water service according to the Rates, Rules and Regulations or Tariff of the Company, as filed with the Pennsylvania Public Utility Commission, which are now in effect or will become effective in the future. The York Water Company will approve this application when you pay, or make satisfactory arrangements to pay, any unpaid charges for services within the past four years.

I understand that York Water will also bill me for sewer services if I live in one of their sewer service areas. * REQUIRED