Forms


Application for Water, Sewer, and Garbage

Name Service Will Be In

(Applicant or Business Name)

Service Address

(Location)

Mailing Address for Billing

(If different from Service Address)

Applicant Information

Applicant

Co-Applicant

Name

SS# or Mississippi DL#

Email Address

Phone#

Date of Birth

If Business, Owner's Name

Emergency Contact

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.

IF WATER IS NOT ALREADY ON AT TIME OF DEPOSIT, SOMEONE WILL NEED TO BE PRESENT, AS WE
CAN NOT LEAVE WATER ON FOR LIABILITY PURPOSES!

If you would like to pay by credit card, please fill out the information below. Deposit amount is $180.00 (residential) plus a $20.00 service charge; totaling
$200.00. 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.

A COPY OF A STATE ISSUED, UNEXPIRED ID IS ALSO REQUIRED. COPYING OF MILITARY ID IS UNLAWFUL

Mailing Address: P.O. Box 1800, Ocean Springs, MS 39566-1800
Delivery Address: 1018 Porter Avenue, Ocean Springs, MS 39564