Article Content "*" indicates required fieldsName(s)*Mailing Address*Mailing AddressService Location*Property Type* Residential Non-residential Mix of residential and non-residentialResidential Information* single family multi-unit home occupation on siteNumber of Units*% of building used for non-residential purposes*[information required by Maine Revenue Services (207) 624-9693]Residential building has fire sprinkler connection on domestic line. # of sprinkler heads:*Owner Information* Owner of property TenantProvide landlord information below (Note that application/account information may be provided to the landlord by law.)Landlord*Landlord address*Employer/source of income*Daytime phone(s)*Email* Previous service with Bangor Water* Yes NoPrevious addressDo you have unpaid bills at this utility or for any other kind of utility service?* Yes NoHave you declared bankruptcy within the past six years?* Yes NoDoes anyone at this location have a medical condition that requires life support equipment or emergency restoration of water if service is interrupted?* No YesDoctor certification is requiredI hereby contract for water service (domestic and/or fire protection), and agree to abide by terms of service (including termination of water/fire protection for non-payment) and related requirements until I give proper notice to terminate service. I understand that: my account information may be used for debt collection by Bangor Water; the information I provide is subject to verification; and provision of incomplete or false information is grounds for termination of service and possible law enforcement.Signature*Person 1SignaturePerson 2Name*Person 1NamePerson 2Signature required for each person on accountDate* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.