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Revision 11.07.19
APPLICATION FOR NEW MONTHLY SERVICE
(Applications accepted Monday Friday 8:00am 4:00pm)
*Service Type: [ ] Residential [ ] Business
*Order Type:
[ ] New Service [ ] Transfer [ ] Landlord
*Own or Rent: [ ] Own [ ] Rent
*Required Fields
Documents
Needed: (Please Note: Additional Documents May Be Required)
Signed Settlement Statement/Tax Bill/Deed (Owner) or Lease Agreement (Renter)
Valid Government Issued picture id for everyone on the Settlement Statement/Lease and W9 (Business)
Management Agreement (if you will have your property managed by a third party)
*Date You Would Like to Start Service: / / (If Available, Same Day Service May Require Additional Fees)
*Name of Applicant/Business:
*SSN/Tax I.D.: *DOB: *License/ID#: *License State:
*Tel/Cell: *Employer: *Employer Telephone:
Name of Co-Applicant:
SSN/Tax I.D.: DOB: License/ID#: License State:
Tel/Cell: Employer: Employer Telephone:
*Service Address:
*City:
*Zip Code:
Mailing Address (if different): City: Zip Code:
City:
Zip Code:
*Have you ever had service with Rockdale Water Resource? Yes or No?
If Yes, please provide service address:
Would you like to disconnect those services? Yes No If Yes, on what date
/
/
*Reference Name: _____________________________________ *Tel/Cell :
If Renting: (If applicable, application will not be processed if landlord information is not listed)
Name of Landlord/Property Owner: Telephone:
Address: City: Zip Code:
Authorized Person Name
(Other Than Customers)
to discuss account
:
I hereby consent to receiving email to my email address provided from Rockdale Water Resources or its Affiliates and their agents, including, without limitation,
Account Management Companies and Independent Contractors, including Debt Collection.
88888888888888888888888888888888888888888888888ttttttttttttttttttttttttttttttttttt
*Email Address *Email Consent: Yes No (Initial Only)*
“Rockdale Water Resources is perfectly positioned to provide the ultimate resource WATER”
958 MILSTEAD AVE CONYERS, GEORGIA 30012
www.rockdalecountyga.
gov
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Revision 11.07.19
Existing Development with Water/Sewer Already Established at Locations:
$50.00 Administrative Fee Due at the time of Establishing New or Transferred Service (Non-Refundable)
New Development Location with No Existing Water Meter or Sewer at Location:
$200.00 Application Fee due at the time of purchasing a meter for a new development location (Non-Refundable)
$200.00 Application Fee due at the time of purchasing new sewer service for new development (Non-Refundable)
Deposits: A Deposit Payment maybe required at the time that new service is established. The deposit amount may vary based on the
type of service and results from a soft credit check.
AP
LOCATION # - CUSTOMER #
CO
LOCATION # - CUSTOMER #
FIRE LINE
SIZE
IRRIGATION
SIZE
WATER
SIZE
RWR OFFICE USE ONLY
ROCKDALE COUNTY FEES
To aid Rockdale Water Resources in the review and acceptance of this application, Applicant and Co-Applicant unconditionally
agree to comply with all applicable Ordinances, rules and regulations of same
( as currently in force and as may be la ter amended)
,
and to promptly pay for all water provided and wastewater treatment used. This includes all service billings, and if applicable, late
fees, and other fees and charges as they may apply. If bills and charges are not paid when due, Applicant and Co-Applicant also
agree to be subject to reasonable attorneys’ fees, costs of collection and filing fees, and Applicant and Co-Applicant hereby consent
to venue in Rockdale County, Georgia should Rockdale Water Resources be required to bring such an action.
By providing Rockdale Water Resources with Applicants’ or Co-Applicants’ cellular phone numbers, each hereby consents to
receiving personal, auto-dialed and/or pre-recorded message calls to their cell phones(s), and to any other phone number(s)
provided to Rockdale Water Resources, its agents and affiliates, including, without limitation, any account management
companies and independent contractors, including debt collectors.
Applicant and Co-Applicant hereby grant Rockdale Water Resources permission to apply for their credit scores and each
understands that the amount of security deposit may be determined by said credit score(s). The Applicant and Co-Applicant further
acknowledge
(jointly and severally)
their responsibility for any accrued cost by Rockdale Water Resources to cause replacement or
repair to Applicant’s and Co-Applicant’s service(s) due to damage and/or tampering.
*Applicant Signature: Date:
Co-Applicant Signature: Date:
Please submit your completed application and required documents to:
Email: newwaterservice@rockdalecountyga.gov
In Person: 958 Milstead Avenue, Conyers, GA, 30012
Mail: Rockdale Water Resources, P.O. Box 1378, Conyers, GA, 30012.
Fax: (770) 918-6514 (IDs will need to be emailed or brought into the office)
Once all documents are received, please contact our office at (770) 278-7400 or a Customer Service Representative will contact you to
collect all fess that are due for your new service. All documents and payments are required to be in by 4pm in order to receive service the
next business day.
“Rockdale Water Resources is perfectly positioned to provide the ultimate resource WATER”
958 MILSTEAD AVE CONYERS, GEORGIA 30012
www.rockdalecountyga.
gov
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