Customer Request Form

SUBMIT AND ELECTRONICALLY SIGN YOUR DOCUMENTS ONLINE (START/TRANSFER WATER SERVICE ONLY)

Complete the form within an hour. Your progress will not be saved until you click Submit at the end. A countdown timer is displayed for your convenience. Refreshing the page restarts the timer, but you will lose all information.
* Indicates Required fields

Customer Information
First Name*:	Required
Last Name*:	Required
Service Address*:	Required
Contact Phone Number*:	Required
Account # (if available)	Value must be numeric
Customer #: (if available)	Value must be numeric
Email address*:	Invalid Format! Required
Request Type*:	Required

Please upload the relevant document. Attachments:*
Comments:

To process your request, please attach required documentation:
Start/Transfer Water Service: Customer Order Form - DPW 92-0004 Continuity of Service Agreement (Landlords Only) Copy of drivers license or other picture identification with signature Copy of final closing statement or water letter from your escrow company or grant deed (Homeowners Only)
Request Refund: Refund Request Form
Declaration of Household Income: Declaration of Household Income form – PW 92-0061
Water Bill Appeal: Water Bill Appeal form – PW 92-0062
Change of Billing Address: Change of Address Form
Downsize your Water Meter: Meter Reduction Form - WW 171 (Reduction Only)
Change to an Existing Water Service including Upgrade or Relocation/Fire Flow Availability Request: WW620 - New water service checklist - (224KB) New Service Connection - WW 172 Fixture Unit Determination - WW 174 WW1775 – Fire Flow Information Request Form Summary of Water Demands - WW 190 Customer Order Form - DPW 92-0004 FFA195 - Fire Dept Information on Fire Flow Availability for Building Permit For Single Family Dwellings FFA196 - Fire Dept Information on Fire Flow Availability for All Buildings Other Than Single Family Dwellings Fire Flow Information Request CHECKLIST_Public Counter (2016) - (56KB) Copy of drivers license or other picture identification with signature Copy of Grant Deed, Fire Departments requirements, a plot plan, and subdivision requirements as applicable
Temporary Construction Water from Hydrant: Temporary Construction Meter Application & Invoice Construction Meter Removal Request
Fire Sprinkler Design Information Request WW1775 – Fire Flow Information Request Form
Inspection Inspection - General Inspection Request Form - (103KB) Inspection - Unlock Request Form (for Antelope Valley Office ONLY) - (97KB) Inspection - Certificate of Occupancy Request Form (for Antelope Valley Office ONLY for properties in the City of Lancaster) - (128KB) WWD - Backflow Prevention Assembly Field Test and Maintenance Report Form - (29KB)

CUSTOMER REQUEST FORM