Water Service Agreement - Grayson County Water District

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.)

Yes
No

Billing Address *

Same as Service Address
Different

Billling Address

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Email

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? *

Yes
No

Copy of Plumbing Permit

Click or drag a file to this area to upload.

Signature *

Clear 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 *