Owner Application for Water & Sewage Service

I hereby apply for water and/or sewer service and agree to comply with the Rules and Regulations of the Willingboro MUA including paying for water and sewer services as bills rendered for the following property:

Property Address

Owner's Name

Phone Number

Mailing Address (if different from property)

Owner's Signature
[signature* owners-signature background:#efefef cols:500 attachment]

Date