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

   ****This form is ONLY for moving from a city address to a city address****  

   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. This deposit will transfer if tenant is moving into another residential rental. 

   Please contact the City of Waynesboro Utilities Office at 942-6643, Option 4, if you have any questions

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. Current Service Address in Waynesboro
14. Service Stop Date*
    Service Stop Date

    Service Stop Date
16. Address # and Street*
17. Apt. or Unit #
19. City
20. State
21. Zip
23. New Service Address in Waynesboro
24. Service Start Date*
    Service Start Date

    Service Start Date
26. Address # and Street*
27. Apt. or Unit #
29. City
30. State
31. Zip
33. Mailing Address (If Different than New Service Address)
35. Address # and Street
37. City
38. State
39. Zip
43. 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

45. Garbage Service?*

    1. Yes
    2. No
46. # of Cans Requested *
50. Primary Applicant
52. Last Name*
53. First Name*
54. Middle Initial*
56. Driver's License Number/State ID#*
57. Phone Number*
58. Email Address*
60. Secondary Applicant

    (This person is also responsible for the bill, and can make changes to the account. )

62. Last Name
63. First Name
64. Middle Initial
66. Driver's License Number/State ID#
67. Phone #
68. Email Address
70. Authorized User
    (City may contact and/or contact City on your behalf. This individual is not responsible for the bill, but city staff can discuss account information with them)
71. Phone Number
75. Date and Time of Application
    Date and Time of Application

    Date and Time of Application
Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit Submit and Print

* indicates a required field