E-Gov Services City of West Carrollton

Water Connect/Disconnect

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Purpose. This form is used to communicate with city personnel to request water & sewer service to be cut on or cut off.

* Information is required.

Contact Information

* First Name:
* Last Name:
* Business Name:
Email:
* Daytime Phone:	() –
Fax:	() –
* Address:
* City:
* State:
* ZIP:

* What date do want service turned on or off.

* Turn On or Turn Off?

Turn On

Turn Off

If turn off, please include new mailing address for final bill.

Check here to have email confirmation of this request sent.

* Information is required.

Notes:

If you send us a message, you'll receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Information we receive may be considered public information which is subject to disclosure under current state law. Learn more about our Privacy Policy.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.