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This form is an application for new water service with the City of Jesup. Upon submitting this form, you must present the following:
Drivers License or State issued ID,
a copy of your rental agreement or closing papers,
and a Deposit of $125 and $30 Connection Fee. Any outstanding bills due must also be paid in full prior to new service.
Upon completion of this form you must call City Hall at (912) 427-1313 or visit us at 162 E. Cherry Street in Jesup to complete payment for your service request. Service will not be connected until payment has been received.
FOR COMMERCIAL ACCOUNTS, please list the name of the business if you would like the account listed under your business.
Address of requested water service in Jesup
Please enter date you would like service to begin. ****Note service is only connected on Mondays, Wednesdays, and Fridays.
Address where bills should be mailed
Please select one:
A copy of your Drivers License or State issued ID,
and a copy of your rental agreement or closing papers is required. Please upload here, bring to City Hall or email the water department staff at firstname.lastname@example.org or email@example.com
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Please type your first name. middle initial, and last name.
This field is not part of the form submission.
* indicates a required field