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Application for New Utility Services

  1. City Logo
  2. Application for New Utility Services

    1. Completed, dated and signed service application.
    2. Proof of ownership/authorization (HUD, final settlement statement, warranty deed or valid lease/rental agreement).
    3. Copy of valid applicant's government-issued identification; such as state drivers license, passport, etc.
    4. Deposit amounts are as follows (customer service will call you for payment):
    • $50.00 Water Deposit (3/4" Connection)
    • $50.00 Sewer Deposit (3/4" Connection)
    • $30.00 Non-Refundable Service Fee
             $130.00 Total to initiate new service
    All paperwork and deposits must be in our office by 3pm on date requested to start service.
  4. Please Note: Start date cannot precede application date, nor can Start Date occur on a weekend or holiday.
  5. Utility Service Request Type*
  6. Residence*
  7. Is Mailing Address different than Service Address?*
  8. Has the City of West Melbourne provided services to you before?*
  10. Would you like to receive paperless billing to the email address above?*
  11. Are you interested in automatic withdrawals from your bank account?*
  12. If you selected YES to automatic withdrawals, we will email you a form to fill out to the email provided above on the day we set up your new service.
  13. Customer Acknowledgment
    I (applicant) hereby request the City of West Melbourne to provide utility services at the above service location. I (applicant) agree to pay all charges for services rendered as a result of this request. I (applicant) understand and agree that failure to pay any amount due to the City can result in services not be connected/reconnected until such payment has been received.
  14. The account must be closed in writing, can be done in person, email, fax or by mailing a signed letter from the account holder(s) requesting to disconnect the water. The deposit will be applied to your final bill. You will receive a final bill with either a refund or a balance due. If a balance is due, please pay promptly.

  15. Please upload your proof of ownership/authorization as listed above.
  16. Upload a copy of your photo identification here.
  17. Leave This Blank:

  18. This field is not part of the form submission.