Utility Service Application

2. Activation of Service Requirements
   • Completed application
   • Government photo ID
   • Service fee and/or Deposit paid 

   Rental applicants must provide a signed and dated rental/lease agreement with the owner's name and phone number. Verification of compliance from the Building Department is required for commercial applicants. Purchaser applicants can establish service in advance of closing. A copy of the property deed is required within five (5) business days of closing.

4. Application Type*

   1. New Construction Application
   2. Residential Application
   3. Commercial Application
5. Date Service to Begin*
   Date Service to Begin

   *One business day notice required | Monday-Friday except holidays

7. Service Address*
9. City*
10. State*
11. Zip Code*
13. Lot
15. Mailing Address

    *If different than above

17. City
18. State
19. Zip Code
21. Lot
23. Primary Applicant/Business Name*
24. SSN or FEIN*
26. Upload Government Issued ID*
27. Email*
29. Primary Phone*
30. Work Phone
32. Have you had prior utility service with the City of Pelham?*

    1. Yes
    2. No
34. Secondary Applicant Name
35. SSN or FEIN
37. Upload Government Issued ID
38. Email
40. Primary Phone
41. Work Phone
43. Upload Property Deed
45. Bill Preference*

    1. Mail
    2. Email
46. Is this a rental property?*

    1. Yes
    2. No
48. Owner's Name/Management Company*
49. Phone*
51. Mailing Address*

    *If different from above.

53. City*
54. State*
55. Zip Code*
57. Manager Name or Local Contact Person*
59. Email*
60. Phone*
62. Upload Signed and Dated Rental/Lease Agreement*
64. General Information Concerning Utility Accounts
    Please follow this link to read important information about utility accounts.
66. Acknowledgement*

    1. I have read and understand the information provided herewith and agree to abide by the terms and conditions as set forth by Pelham Water Works.
    2. The City of Pelham does not provide or restore water service to an existing property with an unpaid balance.
68. Primary Applicant Electronic Signature*

    This electronic signature is intended to be the legally binding equivalent of a handwritten signature. By signing electronically, you acknowledge and agree that your electronic signature carries the same legal weight, validity, and enforceability as a traditional handwritten signature under applicable laws and regulations, including the U.S. Electronic Signatures in Global and National Commerce Act (ESIGN Act) and the Uniform Electronic Transactions Act (UETA).

    If you do not wish to sign electronically, please contact us for alternative signing methods.

70. Co-Applicant Electronic Signature

    This electronic signature is intended to be the legally binding equivalent of a handwritten signature. By signing electronically, you acknowledge and agree that your electronic signature carries the same legal weight, validity, and enforceability as a traditional handwritten signature under applicable laws and regulations, including the U.S. Electronic Signatures in Global and National Commerce Act (ESIGN Act) and the Uniform Electronic Transactions Act (UETA).

    If you do not wish to sign electronically, please contact us for alternative signing methods.

Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit

* indicates a required field