New Service Form – Residential

APPLICATION FOR SERVICE

Charles Town Utility Board
661 S George Street, Charles Town, WV 25414

Items required to setup new service:
Picture ID for all adults (18+ years of age)
Proof of residency. If renting — rental or lease agreement signed by all parties. If purchasing — any document displaying applicant as the owner of the property.
Application signed by all adult tenants if renting or property owner if purchasing
Deposit. Amount varies, please check with cashier
IDs for all adults listed on lease or deed are required

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Name
Address for Service
Address for Bill
Own or Rent Location
Service can be stopped or started during business hours only.
I HEREBY AUTHORIZE SERVICE TO BE ESTABLISHED IN MY NAME AT THE ABOVE PROPERTY LOCATION AND AGREE TO PAY FOR SERVICE UNTIL DISCONTINUED BY MY REQUEST IN WRITING