Application for Water Service

2. 

6. Property Address Information

8. Street Number*

9. Street Name*

10. Address Sublocation

12. Map & Parcel Number*

    Note: This must be the 13 digit Map and Parcel ID

14. Property Owner Contact Info

16. Name*

17. Contact Email Address*

19. Mailing Address (Street / Number or PO Box)*

    This address will be used for billing purposes.

21. Mailing Address (City, State Zip)*

22. Contact Telephone #*

24. Service Installation Details

26. Type of Occupancy*
    -- Select One --ResidentialCommercial

28. Curb to Building (Feet)*

29. # of Dwelling Units

30. Size of Service Line*

32. Name of Qualified Contractor Performing Work

34. Scope of Installation

    Please include any specific information that may be pertinent to this installation.

36. Terms
    By submitting this for you are applying for water service at the Property Locations reference above and agree to comply with the rules and regulations of the Westfield Water Resources Department and agree to be bound by all city ordinances, rules and regulations pertaining to water use in the City of Westfield, and have received a copy of the Westfield Water Resources Department Rules and Regulations.

    By submitting this for you are applying for water service at the Property Locations reference above and agree to comply with the rules and regulations of the Westfield Water Resources Department and agree to be bound by all city ordinances, rules and regulations pertaining to water use in the City of Westfield, and have received a copy of the Westfield Water Resources Department Rules and Regulations.

37. Important Dates
    Please note we cannot process applications for new connections between November 14th and April 16th. If we receive your application during this period, it will be processed after April 16th.

    Please note we cannot process applications for new connections between November 14th and April 16th. If we receive your application during this period, it will be processed after April 16th.

39. Check here to state you understand the statements above.*

    1. I Agree

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

* indicates a required field