Non-Residential Property Application Name(s) (required) Mailing Address (required) Service Location (required) Owner of Property or Tenant Owner of Property Tenant Provide landlord information below (Note that application/account information may be provided to the landlord by law.) 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 kind of utility service? (required) Yes No Have you declared bankruptcy within the past six years? (required) Yes No Does anyone at this location have a medical condition that requires life support equipment or emergency 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 grounds 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) 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.
