Panama City, FL, 32401, US
Type of Service
Deactivation and Activaton Dates must be within 10 days of the other. Service at current address and new address may overlap if needed.
Deactivation Date for Current Address
Activation Date for New Address
Requested Activation or Deactivation Date
PERSON LIABLE FOR PAYMENT
Applicant Date of Birth
Previous Business Account Address
Bill Delivery Address:
Nearest Relative Not Living With You
Is There Other Person(s) That Can Act For You?
Authorized Person Date of Birth
Is there another person you would like to list?
2nd Person Date of Birth
Is there a Landlord?
Landlord Full Address
Related to Landlord?
If you are completing this application from a smartphone or tablet, snap a picture of your Govt. issued picture I.D. along with the cover page of your lease and attach to the application in the fields below. Most all file formats are accepted (PDF, JPG, PNG TIFF etc).
Upload Copy of Photo ID
Copy of Lease/Agreement
BY SIGNING BELOW YOU AGREE TO THE FOLLOWING
The undersigned applicant for residential water/sewer/garbage service states that the information provided in this application for city utilities is true and accurate to the best of applicant's knowledge. Applicant also understands that all charges are due as billed and accepts total responsibility for payment of all charges incurred for the services provided, including reasonable attorney's fees and costs incurred for collection of the unpaid balance.
Furthermore, the undersigned applicant consents that water services provided at the location listed may be turned on without applicant or applicant's representatives present. Applicant further agrees to hold the City of Panama City and its employees HARMLESS should the property, building(s) or premises incur damage as a result of water connection.