Account Address/Phone Number Change

Etowah Water and Sewer Authority require this authorization form to be completed to prevent the unauthorized use of your water account.

1. Print and complete all fields on this form. Authorize by signing the form, fax form to (706) 216-6170.
2. Complete the form below and submit.
Water Account Number*
Name on Account*
Service Address*
Billing Address Now*
Street Address Address Line 2 City State ZIP Code
Billing Address Change*
Street Address Address Line 2 City State ZIP Code
Name*
First Last
Contact Phone Number*
Date*
MM slash DD slash YYYY
Signature*
Comments
This field is for validation purposes and should be left unchanged.

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