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Start/Stop Service Online Request Form

Webform

If you are requesting to start service, please review the Water Service Turn-On Release Agreement.

This form is intended to be used to obtain general information about your account with EMWD.

Note: Please do not provide sensitive information such as your Social Security Number, bank account or credit card number, or information that would enable someone to access an online account such as your username and password.

Information about how EMWD will use your information can be found within EMWD's Privacy Policy.


Please complete the following to STOP service

For security and privacy purposes, please DO NOT provide your full social security number.

Contact Information
Please complete the following to START service
Service Address

Please provide an accurate number of people living in the home to ensure you are provided with the appropriate water budget.

Personal Information
Contact Information

For security and privacy purposes, please DO NOT provide your full social security number.

Electronic Signature(s)
7948944 » If you have a visual disability, please type the numbers two one three three into the box. Your submission will be promptly reviewed by a validation service and sent to the site administrators.
By proving you are not a machine, you help us prevent spam and keep the site secure.

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