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5. Return of Customer Water & Wastewater Deposit

7. To be eligible for a deposit refund, the customer's account can not have been disconnected due to non-payment for a period of one (1) year.
9. Account Number
11. Account Name*
    It is required that the individual or organization that is making the request for refund certify that they are the legal owners of the deposit.
13. Service Address*
15. Deposit Amount
17. Email Address*
19. Note: Per City Code of Ordinances Sec 39-71 (f) An account where the deposits have been returned but the customer had water and sewer service subsequently disconnected for nonpayment shall be required to pay a deposit.
21. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Electronic Signature
27. Finance Department Use Only:
29. Account Status
31. Initials
33. Date Reviewed
    Date Reviewed
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field