APPLICATION FOR NEW SERVICE
PO BOX 4009 * 7412 Emerald Drive Emerald Isle, NC 28594 Office: (252)354-3307 Fax: (252)354-2563
NOTE: PLEASE UPLOAD OR MAIL IN A LEGIBLE COPY OF YOUR DRIVERS LICENSE WITH YOUR PAYMENT.
PAYMENT WILL NEED TO BE RECEIVED IN FULL BEFORE SERVICE CAN BEGIN. PLEASE MAIL CHECK FOR TRANSFER FEE $20.00 DEPOSIT $100.00 OR STOP BY OUR OFFICE.
APPLICANT'S NAME(S) NOTE: Please include this information for any and all persons named on the deed or lease agreement. *
Are you renting or owning this property? - NOTE: if renting please include copy of lease agreement. *
Required
if Renting: Please upload copy of signed lease agreement
SERVICE ADDRESS *
MAILING ADDRESS *
DATE SERVICE IS TO BEGIN *
MM
/
DD
/
YYYY
DRIVERS LICENSE# & STATE *
Please upload a copy of Drivers License *NOTE: if renting include copy of license for all persons listed on lease agreement. *
Required
DAYTIME PHONE #
CELL PHONE # *
SIGN UP FOR TEXT ALERTS
EMAIL ADDRESS *
SIGN UP FOR EBILLING
http://www.boguebankswater.com/documents/175/2018-01-01_BBWC__Policies_and_Procedures.doc **Your electronic signature below indicates that you have read & understand the Policies & Procedures in the link above. * *
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