Form  - First-Time Customer Request

You should use this form if you are a First-time Customer. DMWW requires two (2) business day's notice in order to set up service. 

All questions must be answered, unless marked otherwise. If submitted electronically, these details will be sent via our secure server.

Request Connection

  

Requested Connection Date
(Service will be connected during normal business hours. (Mon - Fri) two business day notice required)
The property is	Owner Occupied Renter Occupied
Personal information
Last Name		First Name		MI
Service Address		Home Phone
City, State		Work Phone
Zip Code		Cell Phone
Email Address
Please add mailing address (if different from service address)
Mailing Address
Mailing City, State
Mailing Zip Code
Secondary Name on Account and address if different
Last Name		First Name		MI
Service Address		Home Phone
City, State		Work Phone
Zip Code / +4		Cell Phone
Email Address