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CoS Water | Request Form
Transfer Your Utility Service
*
Required Field
Customer Information
I am
an Individual
a Business
*
Business Name
*
Employer Identification Number (EIN)
Additional instructions for businesses.
Please enter your Business Name and Employer Identification Number (EIN) above, email the water department at
wateronline@salina.org
, scan and attach your Articles of Incorporation or Articles of Organization as well as your EIN documentation from the IRS you received after completeing your SS-4 application.
*
First Name
Middle Name
*
Last Name
*
Social Security Number
-
-
*
Date of Birth
Click the calendar icon to easily choose the birthday or enter as mm/dd/yyyy.
*
Primary Phone
(
)
-
Alternate Phone
(
)
-
**
E-mail
*
Confirm Email
This must match your Email exactly
**
To start, stop or transfer services online, you must have an e-mail address where we can send your confirmation or contact you in the event we cannot sign you up for service based on the information provided.
Where are you transferring the service from?
*
Transfer From Address
Apt #
***
Desired Stop Date
***
Requested turn off date must be at least 2 business days after todays date on a weekday. Required.
Where are you transferring the service to?
*
Transfer To Address
Apt #
Are you owning or renting at this address?
*
Owner
Renter
*
Desired Start Date
*
Morning 8:00-12:00pm
Afternoon 1pm-5pm
A note about start dates
Requested start date must be at least 2 business days after today's date.
An initiate fee of $10.00 is required to start services for water. This fee will be billed on your first bill.
To protect our customers, we require someone of legal age to be available at the address when our representative starts the water service. If no one can be at the service location during the time selected above, as a convenience to our customers, we offer a
Release Agreement
. Release Agreements are not recommended as there is a real potential of damage when water service is restored without access to the building. By agreeing to the release, it releases the City of all liability for damage caused by running water.
*
Someone will be at the service location as selected above.
OR
I have read and agree to the terms and conditions of the
Release Agreement
.
Trash Service
A note about sanitation service
An initiate fee of
$12.00
is required to start services for sanitation. This fee will be billed on your first bill.
The monthly rate for sanitation services is
$19.75
.
To view the pickup date for the service address, view our
map
.
Please note that it may take a couple days after the initiate date to receive a polycart.
No additional items or bags will be picked up that are left outside of the polycart.
If you wish to have additional items picked up, YOU MUST CALL (785) 309-5750 TO SCHEDULE A SPECIAL PICK UP.
Trash Cart
*
Would you like trash service to the address you are moving to? The monthly fee is $19.75.
Yes
No
*
How many carts would you like?
1 Cart ($19.75/month)
2 Carts ($22.00/month)
3 Carts ($25.00/month)
4+ Carts ($28.00/month and an additional $2.00 for each extra cart)
Notification Options
If you would like to receive your utility bills by email, please choose from the following. Otherwise, leave blank.
Billing Summary by Email Only
Billing Summary by Email and U.S. Mail
Special Instructions
Use only if you are requesting to Start or Stop Water Only and/or Sanitation (Trash) Only.
Terms of Service
By submitting this form, you agree to the following terms of service:
Your application for service must be received by City of Salina Billing at least
two business days
before the date you want service. Your requested date should be a business day. If a non-business day is requested, service will be initiated on the first business day after the date you requested.
You need to have an e-mail address where the City can send a confirmation of your request, or to contact you in the event we are not able to establish service based on your online application.
You agree to be responsible for the protection and preservation of the water meter and will pay for the cost of repairs should the meter be damaged by freezing, imroper thawing, hot water, steam or vandalism, while on your premise.
You agree to comply with the rules and regulations for the operation of the
Water and Wastewater Department
as set forth in
Chapter 41
of the
Salina City Code
or changes thereto.
*
I agree to the above terms.
(this box must be checked to continue)
City of Salina Water Department
City/County Building
300 W. Ash Street, Room 102
Salina, KS 67401
Open Monday through Friday from 8:00 AM to 5:00 PM, except holidays.
Copyright ©2018
City of Salina, Kansas
. All Rights Reserved
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