Please complete the online form below to begin water and sewer services. Applications will be processed the next business day.

Service Information:

Service Beginning Date (must be a business day):*

Service Address:*

Choose One:*

PICK ONE Owner Renter Management Company Contractor

Applicant's Information:

Name:*

Mailing Address (if different from service location):

City, State Zip

Phone Number:*

Email Address:*

Driver's License Number:*

Social Security Number (last 4 digits):*

Employer:*

Address of Employment:

Co-Applicant's Information:

Name:

Phone:

Driver's License Number:

Social Security Number (last 4 digits):

Employer:

Address of Employment:

Name/Phone number of nearest relative not living with you:*

I would like to add this account to my existing auto-pay I have in place with the City of Silverton. This is not for customers currently using Xpress Bill Pay.
*

Yes

No

Property Owner/Management Company Information

Name: *

Mailing Address:

City, State Zip

Phone Number:

I understand that by typing my name below I agree to the following terms and conditions:

(1) I hereby agree to abide by all rules, regulations, and ordinances of the City pertaining to water/sewer service.

(2) I certify that all information on this application is correct and may be used for collection purposes.

(3) I understand that a copy of this application will be sent to my landlord and he/she may be notified of my account status.

(4) All delinquent charges must be paid prior to any new application receiving water service.

(5) I understand that any returned payments will be subject to a $25.00 return payment fee.

(6) I understand that a security deposit of $100 is due at time of application request and a processing fee of $10 will be billed to my account.

Print Full Name:

When you submit this application you will be taken to a website where you can make your $100 deposit.