The following information is required for the purpose of opening an account. A deposit of $125.00 is required
prior to the initiation of service. A base charge for Barefoot Bay water and sewer will be billed every month
regardless of usage and a $15.00 set up fee will be charged to your first bill. Make all checks payable to BFB
Water and Sewer. A photocopy of the applicant’s and co-applicants driver’s license is required to be
submitted with this application.
Applicant’s Name: __________________________________________________________________________
Co-Applicant’s Name: _______________________________________________________________________
Service Address: ____________________________________________________________________________
Mailing Address, (if different): ________________________________________________________________
Primary Phone Number: _____________________ Secondary Phone Number: _________________________
Email Address: _______________________________________ Date of Initiation of Service: ______________
Alternate Contact: ________________________ Alternate Email Address: ____________________________
Applicant Information: Own* Rent**
* If the applicant is the owner, submit a copy of the HUD-1 settlement statement from the closing, or the
owner information needs to be updated on the Brevard County Property Appraisers website at the time of
** If this is a rental, you will need to provide a copy of the lease and the following information:
Property Owner’s Name: _____________________________________________________________________
Property Owner’s Address: ___________________________________________________________________
Property Owner’s Phone Number: ____________
By signing below, I acknowledge and agree to the following: I hereby certify that all the information
provided in this application is true and correct to the best of my knowledge. I understand that I am
responsible for the prompt payment of all charges at the above service address. I agree to abide by any and
all regulations, policies and procedures for the provision of water and wastewater services as established
and may be modified by the Brevard County Board of County Commissioners.
___________________________________________ __________________________________________
Applicant’s Signature and Date Co-Applicant’s Signature and Date
Barefoot Bay Water & Sewer
931 Barefoot Blvd, Suite 2
Barefoot Bay, FL 32976
Phone: 772-664-5916