Water Service Agreement

This form requires you to provide a copy of your drivers license and the last 4 digits of you social security number. Be sure to answer all questions and allow all attachments to upload fully before submitting the form.

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Name *

First

Last

DOB *

Service Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is this your Primary Domicile? (State tax law requires everyone to declare where their primary residence or "Domicile" is. If this isn't your primary residence, your water service is subject to state sales tax.)

Billing Address *

Same as Service Address
Different

Primary Phone *

Secondary Phone

Last 4 of Social Security Number

When would you like this service connected? *

Copy of Drivers License *

Click or drag a file to this area to upload.

Is this for a New Construction? *

Signature *

The above signed hereby applies for water service with Grayson County Water District and agrees to purchase water service under the rates, policies, rules and regulations of the District. This contract is made and entered into on the date indicated above, between the applicant(s) and the District.

Date Signed *

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