Form Center

Step One

Service Start Date*
Service Start Date
Please list the date water service needs to start in your name.
Ownership Status *
1. Homeowner
2. Renter
First Name*
Last Name*
Secondary Account Holder's First Name
Secondary Account Holder's Last Name
Service Address*
City
State
Zip Code
Subdivision
Service Address Same As Billing Address*
1. Yes
2. No
Address
City
State
Zip Code
Cell Phone Number*
Alternative Phone Number
Email Address*
Notifications
Please go to https://marileewater.com/home and click "Sign Up for Alerts" to opt in to receive important notifications and billing reminders.
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Compliance Questionaire
The following information is requested by the Federal Government in order to monitor compliance with Federal laws. If you choose not to furnish the information below, we are required to note the race/national origin of the individual application on the basis of visual observation or surname.
Ethnicity *
Please choose one:
1. Hispanic or Latino
2. Not Hispanic or Latino
Race*
Please choose one:
1. White
2. Asian
3. Black or African American
4. American Indian/Alaska Native
5. Native Hawaiian or Other Pacific Islander
Gender*
Please choose one:
1. Male
2. Female
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Deposit Information
Upon set-up of this account a deposit is due. The amount of your deposit is dependent upon your subdivision. You will receive an email within 48 business hours with specific information for your new account. The amount of your deposit and specific payment information will be included in this email.
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.
Electronic Signature

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