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2. Application for Water, Sewer, and Garbage
4. Date
   Date
6. Name Service Will Be In (Applicant or Business Name)
8. Last Name
9. First Name
10. Middle Initial
12. Email Address
14. Service Address (Location)
16. Address
18. Mailing Address for Billing (If different from service address)
20. Address
22. Date service is to be put in your name
    Date service is to be put in your name
24. Applicant Information
26. Applicant Name
27. Co-Applicant Name
29. Applicant Email
30. Co-Applicant Email
32. Applicant Phone Number
33. Co-Applicant Phone Number
35. Applicant's Date of Birth
    Applicant's Date of Birth
36. Co-Applicant's Date of Birth
    Co-Applicant's Date of Birth
38. Previous Address
40. If Business, Owner's Name
42. Last Name
43. First Name
45. Tax ID Number or last 4 digits of Social Security Number*
47. Emergency Contact
48. Name
49. Phone Number

51. I certify that the above information is correct, and I agree to the terms and conditions of the Ordinances and Amendments to Ordinances of the City of Ocean Springs regarding timely payment of all bills received for charges, fees, and rates in connection with the services provided by the City. If payment is not received in the Water Department Office on or before the delinquent date for the month, I understand that a 15% late fee will be added to my account. I also understand that additional fees may be applied to my account for various services requested, nonpayment of account, and tampering or destruction of city property. I also understand that should I fail to make payment for bills that are due, the City of Ocean Springs may cut off my water usage as stated in City Ordinance No. 04/13/82, Section 1.

53. If water is not already on at time of deposit, someone will need to be present, as we cannot leave water on for liability purposes!
55. Signature / eSignature
56. Co-Applicant Signature / eSignature

58. The deposit amount is $180 (residential) plus a $20 service charge; totaling $200. Please ask about business rates. Please note that we only accept Visa, Mastercard, or Discover for credit card payments. A 3% administrative fee is added to all credit/debit card transactions.

    PLEASE EMAIL SIGNED LEASE AGREEMENT/WARRANTY DEED AND DRIVER'S LICENSE TO: oswater@oceansprings-ms.gov

    To start the new service, please visit City Hall at 1018 Porter Ave, Ocean Springs, MS 39564.

    A copy of a state-issued, unexpired id is also required. Copying of military id is unlawful.

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60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field