Water/Sewer Service Application Form | City of Dover, Arkansas

Today's Date *

Requested Turn on Date *

Please enter the date you would like your services to be turned on.

Name *

First

Last

Driver's License and Social Security numbers will be required upon submission of this form.

Date of Birth *

Please enter your date of birth

Phone *

Other Phone

Place of Employment *

Employers Phone *

Number of People in Household *

Spouse/Roommate Name *

First

Last

Driver's License and Social Security numbers will be required upon submission of this form.

Service Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is your mailing address the same as your service address? *

Yes
No

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

If mailing address is same as service address, no need to complete this section.

Do you own this property? *

Yes
No

Who are you renting from?

NOTICE!

Deposits for water and/or sewer need to be paid before the services will be turned on. (Deposits should be cash or check). Upon submitting this form, contact the City of Dover, which will 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)

Water/Sewer Application Form

NOTICE!