New Haven Form Center

2. Who Should Fill Out This Form?

   Please submit this form online if you are selling your home, to stop receiving bills for City-provided utilities, including water, sewer, and storm drainage.

   
   

4. Service Information

6. Service Address*
8. Account Number

   If known

9. Effective Date/Date of Closing*
   Effective Date/Date of Closing

11. New Owner Information

13. Buyer's Name*

    Forwarding Address for Closing Bill
    No auto-pay for closing bill.

14. Buyer's Name
16. Seller's First Name*
17. Seller's Last Name*
19. Forwarding Address*
21. City*
22. State*
23. Zip Code*
25. Seller's Email*
26. Seller's Phone*
28. Electronic Signature Agreement

    I hereby, hereby authorize the City of New Haven to turn off services at the given address. I will not hold the City of New Haven or any of its agents responsible if there are any problems because of the disconnect of this water service.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Electronic Signature
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field