Customer Name: 
Service Address: 
Billing Address:   
City or Town:         
 Zip Code:  

Alt Phone:  


I am applying for water service exclusively for the service address above and agree to be responsible for payment
of the water bill as of  

The use of service is:                 Residential                 Commercial              Industrial

 I have reviewed the South Berwick Water District terms and conditions, copies of which are on file at the District office and at

 I agree to comply with all applicable Rules and Regulations of the Maine Public Utilities Commission and the
Terms and Conditions
of the South Berwick Water District.

 have   have not had service in my name from this utility before.

A member of my household    does   does not have a medical condition, life support equipment, or other circumstances
which require emergency restoration if water service is interrupted.

Do you own the property?    Yes        No
If not, please give the property owner's name and address:

Today's Date:              Applicant's Signature: