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2. Use this form for Water - Establish Service Requests in the City of Rome, Georgia.
4. Contact Information
6. First Name*
7. Last Name*
9. Phone Number*
10. Email Address*
12. Service Address Information
14. Street Address:*
16. Date that Water Service Needs to be Turned On*
    Date that Water Service Needs to be Turned On
18. If you are renting a the property that needs water service, please provide a copy of the first page of your lease.
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

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