Request to Start Water Service

Notification to Municipal Billing Specialist is due one (1) week prior to start service date.

For questions regarding water utilities please contact the Municipal Billing Specialist at (608) 723-6225.

Legal Name(s) *

Phone Number *

Secondary Phone Number

E-mail Address

Driver's License / State Identification or Passport Number *

Date to Start Service *

Service Address *

Landlord's Name (if applicable)

Reason for Start Service * Purchasing
Renting
Other (please explain below)

Mailing address (if different than service address)

Address of Last Water Service

Additional Information (optional)

WAVIER. I, the owner, agent, or tenant of the property stated above, hereby informs the Lancaster Water & Sewer Department that the person named above is responsible for the water / sewer utility bills at the above mentioned service address and that non-payment of the bills could result in disconnection of service.

CONSENT TO RELEASE INFORMATION. Pursuant to and in accordance with WI Stat. Sec. 196.137, the Lancaster Water and Sewer Department is hereby authorized to release my/our customer account number, usage, and status information to the landlord / landowner, and on my/our behalf is authorized to request a final utility reading in order to prepare a final billing in conjunction with real estate transactions or closing documentation purposes. (Please note: A landlord / landowner will receive copies of all disconnection notices sent.)

Acknowledgment * I hereby agree to the Waiver and Consent to Release Information stated above.

* - denotes required field