Home Inspection Service Application

2. Service Start Date*
4. Service Address*
6. City*
7. State*
8. Zip Code*
10. Contact Name*
12. Billing Address*
14. City*
15. State*
16. Zip Code*
18. Phone*
19. Email*
21. Upload a government ID*
23. Acknowledgement

    1. I, hereby, authorize Pelham Water Works to turn on the water service at the location listed above for the time period requested for home inspection purposes only. The inspection period will be no longer than five business days. The service fee includes up to 500 gallons of water used during the inspection period. Any usage above 500 gallons will be billed to me at the current water and sewer rates.
25. Electronic Signature*

    This electronic signature is intended to be the legally binding equivalent of a handwritten signature. By signing electronically, you acknowledge and agree that your electronic signature carries the same legal weight, validity, and enforceability as a traditional handwritten signature under applicable laws and regulations, including the U.S. Electronic Signatures in Global and National Commerce Act (ESIGN Act) and the Uniform Electronic Transactions Act (UETA).

    If you do not wish to sign electronically, please contact us for alternative signing methods.

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field