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Application for New Utility Services

  1. City Logo

  2. Application for New Utility Services


    1. Completed, dated and signed service application.
    2. Proof of ownership/authorization (HUD, final settlement statement, warranty deed or valid lease/rental agreement).
    3. Copy of valid applicant's government-issued identification; such as state drivers license, passport, etc.
    4. Deposit amounts are as follows (customer service will call you for payment):

    • $50.00 Water Deposit (3/4" Connection)
    • $50.00 Sewer Deposit (3/4" Connection)
    • $30.00 Non-Refundable Service Fee
             $130.00 Total to initiate new service

  3. PLEASE NOTE:

    All paperwork and deposits must be in our office by 3pm on date requested to start service.

  4. Please Note: Start date cannot precede application date, nor can Start Date occur on a weekend or holiday.

  5. Utility Service Request Type*

  6. Is Mailing Address different than Service Address?*

  7. Has the City of West Melbourne provided services to you before?*

  8. CONTACT INFORMATION

  9. Would you like to receive paperless billing to the email address above?

  10. Customer Acknowledgment

    I (applicant) hereby request the City of West Melbourne to provide utility services at the above service location. I (applicant) agree to pay all charges for services rendered as a result of this request. I (applicant) understand and agree that failure to pay any amount due to the City can result in services not be connected/reconnected until such payment has been received.

  11. The account must be closed in writing, can be done in person, email, fax or by mailing a signed letter from the account holder(s) requesting to disconnect the water. The deposit will be applied to your final bill. You will receive a final bill with either a refund or a balance due. If a balance is due, please pay promptly.

    NO PHONE REQUESTS WILL BE ACCEPTED!

  12. Please upload your proof of ownership/authorization as listed above and a copy of photo identification.

  13. Leave This Blank:

  14. This field is not part of the form submission.