Individual Account Application

Be advised service will begin within 2 BUSINESS DAYS once we complete the application process.

As part of our data security and privacy this form will not ask for any critical personal information such as your social security number or driver's license number. We will call you for this information along with requests for any further documentation/deposit needed to open your account.
Individual Account
Note: Accounts opened by a Guardian Ad Litem or legal Power of Attorney for the account holder, must provide a copy of the appropriate legal documents. Further, as mandated by the U.S. Federal Trade Commission Identity Theft Prevention Program, the City must require applicant’s of individual accounts and sole proprietorships to furnish documented proof of their identity before service is approved in addition to any documentation the City requires. Documentation will be verified.
Service Date Request
Month - Day - Year
Individual Property Type

Residential (Property Owner)
Renter/Tenant (Non-Business)
Landlord
Primary Account Holder Name
As noted on Government Photo ID
Last Name
First
Middle
Suffix
Secondary Account Holder Name (if Joint Account)
As noted on Government Photo ID
Last Name
First
Middle
Suffix
Account & Location Information

Service Address

Mailing Address

Home Phone
Phone Number
Business Phone
Phone Number
Cell Phone
Phone Number
Email
Have you previously had a water/sewer account with the City of Kannapolis?

Yes No
Name account was under?
Last service address:
If you wish to have someone authorized to make inquiries and/or payments on your account, designate them below:
Name of Authorized User
Relationship
Renters/Tenants - Property Owner Information
Note: City policy REQUIRES all renter/tenant(s) to provide a copy of the lease agreement for service.
Name of Property Owner/Property Manager

Property Owner/Property Manager's Address

Home Phone
Phone Number
Business Phone
Phone Number
Cell Phone
Phone Number
Electronic Consent
Acknowledgment: I, the undersigned certify that the information in the foregoing application is accurate and true to the best of my knowledge and belief. I have received a copy of the “Terms of Application”. I acknowledge my responsibility for any and all charges, fees and the like associated with the account, including returned check charges, and agree to notify the Customer Service Center of any changes regarding the account within ten (10) days of the change. I agree that no interest will be paid to me for any deposits, tap on fees or other charges I might pay. If I have supplied you with a wireless telephone number or land line number I am giving you prior consent to call that number. I am aware that such calls may result in charges to my wireless phone account.
Electronic Consent

I consent to the above terms and acknowledgements.
Electronic Signature
Please type your full name as an electronic signature.

Individual Account