Residential Property Application Names(s) (required) Mailing Address (required) Service Location (required) Number Of Units Residential building has fire sprinkler connection on domestic line. # of sprinkler heads Owner of Property or Tenant (required) Owner Tenant Landlord Landlord Address Employer/Source of Income (required) Daytime Phone(s) (required) Email (required) Previous service with Bangor Water (required) Yes No Do you have unpaid bills at this utility or for any other utility service? (required) Yes No Have you declared bankruptcy within the last six years (required) Yes No Does anyone at this location have a medical conditional that requires life support equipment or emergancy restoration of water if service is interrupted? (required) Yes No Doctor certification is required I hereby contract for water service (domestic and/or fire protection), and agree to abide by terms of service (including termination of water/fire protection for non-payment) and related requirements until i give proper notice to terminate service. I understand that: my account information may be used for debt collection by Bangor Water; the information I provide is subject to verification; and provision of incomplete or false information is ground for termination of service and possible law enforcement. Person 1 Name (required) Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures Person 2 Name Date (required) If water service is required to be turned on, please call the office at 207-947-4516 There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
