New Utility Account Application

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Please correct the fields below:

Please correct the field(s) marked in red below:

This application is for setting up a new utility account (garbage & water) in the City of Roswell.

If you have any questions, please contact the Financial Services Division at fsd@roswellgov.com or 770-641-3759.

Please note: A representative will send a confirmation to the email address submitted below after your request has been processed. If you are leasing your property, please email us your leasing contract (first page and last page).

Applicant Information

*

Applicant Information

Customer Name:

Service Address:

Mailing Address:

Phone:ext.

Secondary Phone:ext.

Driver License:

Date of Birth:

Email (required):

Purchase Date or Lease Start Date:

Do you have any prior or current address(es) in the City of Roswell? If yes, provide street address:

Do you own or lease the property at this service address?

*

Do you own or lease the property at this service address?

Own

Lease

Leasing Property Information

Lease Start Date:

Property Owner Name:

Property Owner Address:

Property Owner Phone:ext.

Additional Comments:

Please upload your lease agreement:

Click button for uploading file

Clear

Maximum size allowed: 5 MB

Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

*

Signature (Please type your full name in lieu of your signature):

Date:

Your utility bill will be emailed to your email address on a monthly basis. If you do not want to receive your bill electronically, please email the Financial Services Division at fsd@roswellgov.com.

To receive a copy of your submission, please fill out your email address below and submit.
Email Address