2. Start Service Form
4. Choose One*

   1. Owner

   1. Tenant

   1. Property Manager
6. Property Management Company
7. Property Mgmt Phone Number
8. Property Mgmt E-mail Address
10. Purchase Date/Lease Start Date*
    We cannot go back in time to get a meter read. Please allow several business days for us to obtain a read.
12. Service Address*
14. Customer First Name*
15. Customer Last Name*
17. Secondary Customer First Name
18. Secondary Customer Last Name
20. Company Name (for commercial accounts)
22. Mailing Address
    * If different from service address.
24. Email Address*
26. Phone Number*
27. Secondary Phone Number
31. Please fill out the information below if you are a tenant. Landlord Name or Company. *
33. Landlord Address
35. Landlord Phone Number*
36. Landlord E-mail Address
38. Any additional information you would like to include with your request?
40. Terms of Agreement*

    1. By clicking this box, I agree to the terms and conditions as set out in this application and in the City of Gig Harbor Municipal Code.
42. Application is hereby made by the undersigned for the above stated service location. I agree that all applicable rates and charges for water, sewer, and/or storm service to the above property shall be paid in accordance with the now-existing ordinances and regulations of the City, or any ordinances and regulations passed hereafter. Water and sewer services extended outside City limits shall be charged at 1.5 times the City rate. I understand and agree that failure to pay any amount due to the City of Gig Harbor can result in discontinuation of services until such time as payment has been received. I understand that the City will use all reasonable effort to maintain uninterrupted service, but reserves the right to shut off the water at any time without notice for repairs, expansions, nonpayment of rates or any other reason and assumes no liability for any damages as a result of interruption of service from any cause whatsoever. I am hereby notified that service charges are deemed delinquent if not paid within 30 days following the billing date. Interest at the rate of 8% per annum shall be charged on all delinquent service charges. If charges have not been paid within 60 days of billing, the city shall mail a delinquent/shutoff notice and charged $10.00 for this first notice. If the account has not been settled within the time provided in the notice, then a 24 hour final notice will be issued at the property and the customer shall be charged $15.00. If the account has not been settled within the time provided under the second notice, the city shall shut off service and turn on again after full payment is made for all charges to date plus the $25.00 turn on charge. The city shall have a lien against the premise to which service was furnished and may enforce such lien by shutting off service. Additionally, the city shall have the option to enforce the delinquent utility charges pursuant to other methods allowable by law. (GHMC Ordinance 13.04.050) I understand that I will be charged a $25.00 fee for any returned payments. (GHMC 3.48.020) I further understand that I must comply with the regulation of the State of Washington Department of Health, in the use of water and particularly the Cross Connection Control and Backflow Prevention, GHMC Chapter 13.06, Ordinance 1331.
44. Rental Properties: Billing transfer to the tenant or occupant is for the convenience of the property owner. This transfer does not relieve the owner of responsibility for payment should the tenant/occupant of the service address fail to pay their charges. Collection of outstanding charges for vacated tenants is the responsibility of the owner. The owner of record will be mailed a duplicate delinquent notice should the account become past due. All charges remain against the property and failure to pay may result in discontinuation of service and/or a lien on the property.
48. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
50. Electronic Signature
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field