New Customer Service Form

2. 
4. Please use this form if you are a new customer, need to add a name or change you bill to address, or need to shut off service. If you would like print out this form and deliver in person, you may do so by clicking on the link below and dropping it off at our Main office at 6595 East 70th Ave, Commerce City, Co 80022.
6. Printable New Customer Service Form
8. Application Request*

   1. New Service
   2. Add name or Bill to Address Change
   3. Shut off Request
10. Name of Applicant *
11. Phone Number*
13. Name of Second Applicant
    If needed
15. Service Address*
16. City*
18. State*
19. Zip*
21. Billing Address*
22. City*
24. State*
25. Zip*
27. Previous Address
    Required - If you lived in the District before
28. City
30. State
31. Zip
33. Do you want the water turned:*

    1. On
    2. Off
34. Effective Date*
    Effective Date
35. Are you the owner or renter?*

    1. Owner
    2. Renter
37. Click Here*

    1. I agree my electronic submission of this form constitutes my signature affirming the above information is true and correct.
39. Signature:*
40. Date*
    Date
42. Email Address*
44. Owner:
    If you are not the owner, please list owner's name:
45. Owner's Phone #
47. Owner's Address
48. City
50. State
51. Zip
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field