Start, Stop or Transfer Service

Following receipt of this form, staff will contact you by phone or email during regular business hours to confirm date and time for turning on the service at the new location. Failure to respond to our follow-up contact may result in delays in processing. New service connections require up-front payment of a deposit (ranging from $100 to $250) and $55 service activation fee.

Same-day service may not be guaranteed for requests received after 12:00 pm using this form.

All required fields below must be completed and a government-issued photo ID matching the responsible party listed on the account must be attached in order to process the application. A utility bill confirmation showing your name and the new service address is required to validate the responsible party.

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Have you previously had water/sewer service with the BGJWSC?
YesNo
If yes, last service address:

Service Address Information

Service Address

Service Address Line 2 (Apt, Unit, etc.)

Service City

Service Zip Code

Requested Turn-On Date (mm/dd/yyyy)

Primary Applicant Information

First Name

Middle or Maiden Name

Last Name

Birth Date (mm/dd/yyyy)

Driver's License #

Driver's License State

Primary Contact Cell Phone - Please include to enable us to send you a free alert if your service is at risk of disconnection for non-payment.

Primary Contact Work Phone

Primary Contact Home Phone

Primary Contact Email

Billing/Forwarding Address, If Different from Service Address (not required)

Billing Address

Billing Address Line 2 (Apt, Unit, etc.)

Billing City

Billing State

Billing Zip

Co-Applicant Information (not required)

First Name

Middle or Maiden Name

Last Name

Birth Date (mm/dd/yyyy)

Driver's License #

Driver's License State

Additional Persons

List any additional persons authorized on the account (not required). Will be able to request balance information and allowed to make payments.

Landlord Contact Information (required if property not owned)

Landlord Name

Landlord Primary Contact Phone and/or Email

PAPERLESS BILLING TERMS AND CONDITIONS
The terms and conditions of paperless billing are as follows:
Enrollment: You must be listed on the account as a primary or secondary responsible party to complete this form. By enrolling in paperless billing if you cancel your paper bill, it will be your responsibility to check the Brunswick-Glynn Joint Water and Sewer Commission (“JWSC”) website to obtain your bill if one does not arrive by email. You can expect to begin receiving your monthly statement via email within 30 day. However, you may still continue to pay your bill in person at our office, by mail, or online. Please understand that we don’t control all aspects of email delivery and can’t assure timely delivery.

Acknowledging Receipt: By agreeing to suspension of mailed paper bills, you agree that posting of the bill on the website or via email will constitute your receipt of the bill for all purposes and that the bill is due and payable upon posting. We can only attempt to send the email of your bill if it has a current correct email address for you and you immediately notify us of any change in your email address. If you fail to pay your bill by the due date for any reason, your account may be at risk of disconnection. These actions may include but are not limited to assessment of fees and suspension of service.

Invalid Email Addresses: Any email address change must be reported to us as the primary billing email account is not monitored. Therefore, it will still be your responsibility to check the JWSC website or contact staff in a timely manner and pay your bill by the due date as listed on the bill.

Payments: A printed copy of your paperless billing statement can be used in association with mailing a check for payments. You can also pay online with a one-time or recurring payment on using our Citizen Access Portal.

Service Turn-On Waiver of Liability and Hold Harmless Agreement
Would you like to have your service turned on while no one is present at the property?
YesNo

Comments (not required)

Acceptance of Conditions

I hereby request provision of water and/or sewer service by Brunswick-Glynn Joint Water and Sewer Commission for the premises described herein for which I agree to pay monthly at the schedule rate then in effect when due. I will give notice to the JWSC of my vacating or selling said premises. I will comply with the rules and regulations of the JWSC making them a part of this agreement. In the event of default of payment, the ordinances of the JWSC will apply and any fees assessed for such default will be my responsibility. I agree to claim no damage on account of the stoppage of the flow of water or sewer resulting from accident or the making of alterations, repair or improvement by the JWSC. I agree to keep all plumbing on the premises in repair and promptly stop all leaks. If I fail to comply with this agreement, or any part thereof, the JWSC may turn off the water and/or discontinue sewer services to the premises without notice to me. The JWSC reserves the right to contact the applicant herein at any of the locations described herein.

To reduce the risk of identity theft, you must include the following items:
Attach Government-Issued Photo ID (pdf, jpg or png - 10 mb max)

Attach legal documentation reflecting the applicant’s name and the service address applied for. Examples include: Confirmation of service from a power or gas provider, rental/lease agreement, closing documentation, insurance documentation (renter’s or homeowner policy). (pdf, jpg or png - 10 mb max)