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2. Request for New Water/Sewer Service Account
   Please complete this form to establish a new Village of Northfield water and/or sewer service account. Knowingly providing incorrect or false information invalidates this form and may constitute fraud.
4. Date to Establish Service*
6. Service Address*
8. Resident Name*
10. Billing Address (if different than service address)
12. Billing City, State, Zip (if different than service address)
14. Phone Number*
16. E-mail Address*
18. If this is a rental property, provide the name and address of the property owner or management company
20. Upload a legible copy of your current driver's license or alternate government-issued photo ID*
22. By electronically signing and submitting this form, I recognize that I am assuming the payment responsibility for this utility account from the date provided forward. Signature of New Responsible Party*
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field