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

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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

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Phone *

Other Phone

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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.

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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!

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.

Water/Sewer Application Form

NOTICE!