Water/Sewer Application Form Please enable JavaScript in your browser to complete this form.LayoutToday's Date *Requested Turn on Date *Please enter the date you would like your services to be turned on.Name *FirstLastDriver's License and Social Security numbers will be required upon submission of this form.Date of Birth *Please enter your date of birthLayoutPhone *Other PhoneLayoutPlace of Employment *Employers Phone *Number of People in Household *Spouse/Roommate Name *FirstLastDriver's License and Social Security numbers will be required upon submission of this form.LayoutSpouse/Roomate Date of Birth *Spouse/Roomate Phone *Service Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIs your mailing address the same as your service address? *YesNoMailing AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIf mailing address is same as service address, no need to complete this section.Do you own this property? *YesNoWho are you renting from?NOTICE!Upon submitting this form, a representative of the City of Dover will be in touch to collect the Drivers License and Social Security numbers of both the submitting party, and their spouse/roommate. Signatures of both parties will also be required by visiting the Dover City Hall (8904 Market Street, Dover, AR 72837) before the services will be turned on.Submit