Please fill out ALL customer contact information.

 First Name

 Last Name

 Phone

 Email

If you have your most recent bill, fill in all the fields below. If you don't, you are only required to fill in the Number of units in your property.

Yes No  Do you have you most recent water bill?

$ Enter the dollar amount of your most recent domestic usage water/sewer bill.

 How often are you billed? (in months)

 Enter Your Water Rate in HCF. (1 HCF = 748 Gallons)

 Enter Your Sewage Rate in HCF. (1 HCF = 748 Gallons)

 Enter # of Units in the Property.