Rockdale Water Resources Application Form PDF Details

Are you interested in applying for a water resources project grant, loan or program with Rockdale Water Resources? Knowing how to successfully complete a grant, loan or program application form is essential if you want to access the funding available from this popular organization. Read on to find out what details are required and what information must be included when filling out the Rockdale Water Resources Application Form. We will also share some tips that can help make sure your application stands out from the rest.

QuestionAnswer
Form NameRockdale Water Resources Application Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesrockdale water bill pay, rockdale county water, rockdale water, rockdale county water resources application

Form Preview Example

RWR - Customer Service 958 Milstead Avenue Post Office Box 289 Conyers, Georgia 30012 www.rockdalecounty.org Office: 770-278-7400 Fax: 770-918-6514

COMPLETE FORM, SIGN, DATE &

RETURN TO RWR BY FAX, MAIL

OR IN PERSON

Rockdale Water Resources

APPLICATION FOR WATER/SEWER SERVICE

A copy of the settlement statement (owner) or copy of the lease agreement (tenant) is required to establish a Rockdale Water Resources (RWR) water/sewer account.

Deposit payment is due at time service is established; this is based on water and/or sewer service and meter size.

CUSTOMER NAME

CUSTOMER NUMBER

To Be Assigned by RWR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

START SERVICE ON (Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE SERVICE ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE BILLING ADDRESS

 

 

 

 

 

 

 

 

 

TRANSFER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Yes, PREVIOUS ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

"LEAVE ON" AT PREVIOUS LOCATION

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

"PLEASE DISCONNECT" ON (Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOME TELEPHONE #

 

 

 

 

 

 

 

 

 

 

 

WORK TELEPHONE #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY/TAX ID #

 

 

 

 

 

 

 

DRIVERS LICENSE #

 

 

DATE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYERS NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYERS ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARE YOU (Check One)?

OWNER

 

RENTER

MGMNT CO.

In order for Rockdale Water Resources to accept this application, the Applicant unconditionally agrees to comply with all Rockdale Water Resources ordinances, and acknowledges responsibility for payment of service billings. This includes all late fees and other fees that may apply. The Applicant further acknowledges sole responsibility for any accrued by Rockdale Water Resources to cause replacement or repair to Applicant's water service due to damage and/or tampering. Applicant also understands that if the monthly or final bill is not paid in a timely fashion, the Applicant will be subject to collection fees. There is a non-refundable $50 processing fee due at the time service is established.

SIGNATURE

DATE

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