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4. In order to obtain services please fill out and submit the following application. Service start date must be at least three business days from the submit date. You must also attach all necessary documentation. If you are purchasing or already own a home, we will need the Offer to Purchase, Settlement Statement, Closing Disclosure Statement or a copy of the Deed. If you are renting, we will need your rental agreement. In addition to the paperwork needed, you will also need to submit a copy of your ID. The name on the paperwork is the name the account must be in.
6. Service start date must be at least 3 business days from today's date. If you are in need of same day service, you will need to come into the office.
8. Today's Date*
   Today's Date
9. Date Services to be Started*
   Date Services to be Started
11. Homeowner/Renter First Name*
12. Homeowner/Renter Last Name*
13. Last 4 Digits of SS#*
15. Spouses First Name
16. Spouses Last Name
17. Last 4 Digits of SS#
19. Address of Property to Start Service*
21. Billing Address if Different from Service Address*
23. Home Phone Number*
24. Work Phone Number*
25. Cell Phone Number*
27. Email Address*
29. Water Deposit $100.00
30. Sewer Deposit $50.00
31. Activation Fee $20.00
33. Water Users Agreement
    Water Users Agreement (PDF)

    Please submit the Water Users Agreement document along with the other required forms.
35. Signed Water Users Agreement*
37. Please Upload Offer to Purchase, Closing Disclosure, Settlement Statement, Deed or Rental Agreement*
39. Please Upload Copy of Identification*
41. Hoke County Utilities Rules and Regulations
    Please Keep for your Records
43. Once form is submitted, please allow 1-2 business day(s) for our office staff to contact you to collect payment for deposit and activation fee. If you do not hear from our office after 2 business days, please contact us at that time. If you have any questions in regards to completing the online application for service, please contact our office at (910) 875-6704.
45. Submission of this form online does not guarantee service. Service cannot be started until all necessary documentation is received and payment is made.
47. This institution is an equal opportunity provider.
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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field