New Customer Application Step 1 of 2 50% General InformationName* First Last Home PhoneWork PhoneCell Phone*Email* (Email is used in case of emergency outages and other updates.)Desired Billing AddressAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Requested Service AddressSubdivision*Cross Creek SubdivisionFarmbrook SubdivisionKingsgate SubdivisionKingston EstatesLauren EstatesStreet Name (Cross Creek)*Cross Creek TrailsCross Creek CircleCrossview RoadStreet Name (Farmbrook)*Sapelo DriveFindley ChaseCatherine CourtPennbrookeTara RoadCarmen DriveStreet Name (Kingsgate)*Oxbottom DriveKnights CtMcAllister StQueensbury WayStreet Name (Kingston Estates)*Orchard WayHeather WayMeaganChris CircleFultondale CircleNada CourtCalijo CourtKingston CourtOld Pine RoadStreet Name (Lauren Estates)*Shelby LaneMeredith DriveStreet Number*Rent or Own*RentOwnLandlord Name / Property Manager*Other InformationStart Date Date Format: MM slash DD slash YYYY InvoiceEmailPaperActive Military?** Yes (A copy of military ID or letter must be mailed, faxed or emailed before or with 1st payment. Otherwise you will be billed a $50 connection fee.) **By submitting this form, you agree to accept and comply with all codes, regulations, and ordinances now or hereinafter in effect concerning use and payment for water service. Connection Fee Price: $50.00 (Please note: this fee is non-refundable)Payment Method - I Want To...*Pay OnlineMail In A CheckCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Total $0.00 Please make out your check to Metro Water Supply and mail it in to P.O. Box 3128 | Valdosta GA 31604. Please put "Application Fee" in the memo line. Thank you.**By submitting this form, you agree to accept and comply with all codes, regulations, and ordinances now or hereinafter in effect concerning use and payment for water service.CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.