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

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

    The deposit for residential tenants (renters) shall be billed at a rate of $75.00 over the first 2 billing cycles for a total of $150.00. 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 (Deposit Required)
   2. Own (No Deposit Required)
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. Water and/or Sewer Services
15. Service Address
17. Address # and Street*
18. Apt. or Unit #
20. City
21. State
22. Zip
24. Mailing Address (If Different than Service Address)
26. Address # and Street
27. Apt. or Unit #
29. City
30. State
31. Zip
35. WEEKLY REFUSE PICKUP

    RATE: $20.00 (AS OF JULY 1, 2023) PER MONTH PER CAN.  BILLED ON WATER BILL EVERY 2 MONTHS ($40.00).

    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 $20.00/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 

37. Garbage Service?*

    1. Yes
    2. No
38. # of Cans Requested*
42. Primary Applicant

    This person is responsible for billing and can make changes to the account. 

44. Legal Last Name*
45. Legal First Name*
46. Middle Initial*
48. Driver's License Number/State ID Card #*

          

49. Phone Number*
50. Email Address
52. Secondary Applicant

    This person is responsible for billing and can make changes to the account. 

54. Last Name
55. First Name
56. Middle Initial
58. Driver's License Number/State ID Card #

     

59. Phone #
60. Email Address
62. Authorized User

    (The City may discuss the account with this individual, but this individual is not responsible for billing and cannot make changes to the account.)

63. Phone Number
67. NAME OF PERSON COMPLETING APPLICATION

    Please Note: Only the Account Holder and Secondary Applicant can make changes to the Utility Account

68. Date and Time of Application
    Date and Time of Application

    Date and Time of Application
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

* indicates a required field