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2. Use this form for Water - Transfer Service Requests in the City of Rome, Georgia.
4. Contact Information
6. First Name*
7. Last Name*
9. Phone Number*
10. Email Address*
12. Current Service Address Information
14. Street Address:*
16. Date that Water Service Needs to be Shut Off*
    Date that Water Service Needs to be Shut Off
18. Transfer Address Information
20. Address Where Water Service Will Be Transferred
22. Date that Water Service Needs to Be Turned On
    Date that Water Service Needs to Be Turned On
24. 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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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

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