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Type of Service

Residence
Business
Industrial Facility
Fire Protection
Public

Requested Service Activation Date (required notice - 5 days)

Primary Account Holder Information:

Primary Account Holder First Name *
Primary Account Holder Last Name *
Primary Account Holder Home Phone *
Primary Account Holder Cell Phone *
Primary Account Holder Business Phone *
Primary Account Holder Email *

Secondary Account Holder Information:

Secondary Account Holder First Name
Secondary Account Holder Last Name
Secondary Account Holder Home Phone
Secondary Account Holder Cell Phone
Secondary Account Holder Business Phone
Secondary Account Holder Email

Service Address:

Address *
City *
State *
Zip *

Additional Information:

Will you reside at this service address?

Yes
No

Send bill to this Address
Send bill to this City
Send bill to this State
Send bill to this Zip
Own *

Own
Rent

Is anyone living at the service address on life support or in critical need of a continuous water supply for some other medical reason? *

Yes
No

If yes, click here to register as a Critical Care Customer.

Are there any special considerations for the meter reader? (unusual meter location, protective pets, etc.)
Is there any other information ESWA should know about this service location?

Note: Easton Suburban Water Authority reserves the right to request a deposit from any applicant for water service. The deposit is an amount equal to the estimated gross bill for any single billing period plus one and one-third times the normal billing cycle usage monthly or quarterly, or a minimum deposit of $100.

Click to review ESWA security and privacy policy

Security Code: *
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