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
   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. 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. Primary Applicant
42. Legal Last Name*
43. Legal First Name*
44. Middle Initial*
46. Driver's License Number/State ID Card #*
47. Phone Number*
48. Email Address
50. Secondary Applicant
52. Last Name
53. First Name
54. Middle Initial
56. Driver's License Number/State ID Card #
57. Phone #
58. Email Address
60. Authorized User
    (The City may contact this person or this person can contact the City on your behalf. This individual is not responsible for the bill)
61. Phone Number
65. NAME OF PERSON COMPLETING APPLICATION
    Please Note: Only the Account Holder and Authorized Users can make changes to the Utility Account
66. Date and Time of Application
    Date and Time of Application

    Date and Time of Application
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit Submit and Print

* indicates a required field