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Welcome

Application to start water and/or wastewater service. For same day service or questions about this application, please call Customer Service at 928-763-0166. Hours of operation are from 8:00 a.m to 5:00 p.m, Monday-Friday, excluding major holidays.

What is the service address? (Where you want service to begin)

Service Start Date

Name of Customer or Business

Employer

Social Security Number

Date of Birth

Phone Number

Driver's License Number

Driver's License State

Billing Street Address (Where you would like your billing statements mailed)

City

State

Zip Code

**All individuals, over 18, listed on the deed or lease will be automatically added to the account as a third party co-responsible. Please provide a state issued ID for each individual**

State Issued ID

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Bullhead City Ordinances - Utility Service

Signature - By signing you agree to the terms of service outlined in the link above

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