3. 
   

5. Return of Customer Water & Wastewater Deposit

7. To be eligible for a deposit refund, the customer's account can not have been disconnected due to non-payment for a period of one (1) year.
9. Account Number
11. Account Name*
    It is required that the individual or organization that is making the request for refund certify that they are the legal owners of the deposit.
13. Service Address*
15. Deposit Amount
17. Email Address*

19. NOTE: IF YOU ARE ELIGIBLE TO HAVE YOUR DEPOSIT REFUNDED, YOU WILL RECEIVE A CHECK IN 2-3 WEEKS AFTER SUBMITTING THIS FORM. DEPOSITS ARE NOT CREDITED TO YOUR ACCOUNT. PLEASE NOTE THAT IF YOUR ACCOUNT IS SHUT OFF DUE TO NON-PAYMENT, THE CITY WILL REQUEST THAT A NEW DEPOSIT BE PLACED.

    ** Double deposits are refunded after 2 years from disconnection date.

21. 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.
23. Electronic Signature
27. Utility Billing Division Use Only:
29. Account Status:
30. Date of Deposit or Last Disconnection:**
32. Initials:
33. Date Reviewed:
    Date Reviewed:
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field