2. 
4. City of Waynesboro Application For Starting Utility Services

   Business' requiring water, sewer, and trash services must complete this Service Application. 

   The deposit for business tenants (renters) shall be billed at a rate of $125.00 over the first 2 billing cycles for a total of $250.00. This deposit will be applied to the accounts final bill. Bills come out Bi-Monthly.

   Please contact the City of Waynesboro Utilities Office at 942-6643, OPTION 4, if you have any questions. Please allow 24 Hours (M-F 8-5) for your request to be processed.

6. Are You:*

   1. Renting
   2. Own
7. Service Start Date*
   Service Start Date
9. Rental Agreement/Lease/Purchase Agreement*

   If you are RENTING please attach a complete copy of your RENTAL AGREEMENT/LEASE. 

   If you have BOUGHT a property, please attach a copy of a CLOSING STATEMENT or DEED or MORTGAGE STATEMENT or RECORDED COPY OF WILL

13. Business Service Address
15. Address # and Street*
16. Apt. or Unit #
18. City
19. State
20. Zip
22. Mailing Address (If Different than Service Address)
24. Address # and Street
25. Apt. or Unit #
27. City
28. State
29. Zip
33. WEEKLY REFUSE PICKUP

    RATE: $17.50 (AS OF JULY 1, 2022) PER MONTH PER CAN.  BILLED ON WATER BILL EVERY 2 MONTHS ($35.00).

    THIS SERVICE IS OPTIONAL AND INCLUDES:

    1. WEEKLY REFUSE PICKUP OF 55 GALLON CITY ISSUED CAN.  (REFUSE DIVISION WILL NOT PICK UP PERSONAL CANS).  ADDITIONAL CANS ARE ADDITIONAL 17.50/MONTH PER CAN.

    PLACE CAN OUT BEFORE 6AM TO ENSURE PICKUP.

    TRASH OUTSIDE OF THE CAN MAY NOT BE PICKED UP

    TO SEE WHEN YOUR STREETS PICK UP IS VISIT https://www.waynesboro.va.us/309/Refuse

    FOR BULK PICKUP INFORMATION/SCHEDULING VISIT https://www.waynesboro.va.us/702/Bulk-Collection 

35. Garbage Service?*

    1. Yes
    2. No
36. # of Cans Requested*
40. Business Applicant
42. Company Name*
44. Federal ID/EIN #:*
45. Company Phone Number*
47. Local Company Contact

    This contact should be the Owner or someone at the physical location in Waynesboro (General Manager or Maintenance Manager). This is who we would contact if a problem arises. 

49. Last Name*
50. First Name*
51. Middle Initial*
53. Phone Number*
54. Email Address*
56. Permission To Discuss Account With
    (City may contact and/or contact City on your behalf. This individual is not responsible for the bill)
57. Phone Number
61. NAME OF PERSON COMPLETING APPLICATION
    Please Note: Only the Account Holder and Authorized Users can make changes to the Utility Account
62. Date and Time of Application
    Date and Time of Application

    Date and Time of Application
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit Submit and Print

* indicates a required field