New Service Form – Business

APPLICATION FOR SERVICE

Charles Town Utility Board
661 S George Street, Charles Town, WV 25414

Items required to setup new service:
Picture ID for owner and employee submitting the application.
Proof of residency. If renting: rental or lease agreement signed by all parties. If purchasing: any document displaying applicant as the owner of the property.
Application signed by business owner.
Deposit. Amount varies, please check with cashier.

ALL CHARLES TOWN RESIDENTS ARE REQUIRED TO CONTACT APPLE VALLEY WASTE FOR TRASH PICKUP.
PLEASE CALL (304) 724-1834 FOR SERVICE.

Please enable JavaScript in your browser to complete this form.

Driver's License *

Drag & Drop Files, Choose Files to Upload

Proof of Residency *

Drag & Drop Files, Choose Files to Upload

Name *

Name *

FEIN/Tax ID *

Address for Service *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Address for Bill *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Primary Phone *

Secondary Phone

Own or Rent Location *

• Own
• Rent

Landlord's Name

Landlord's Phone

Date Service is to Start *

Service can be stopped or started during business hours only.

Date: *

Submit