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Application for Water
$150.00 Deposit

City of Patterson
3507 Williams Street, PO Box 434
Patterson, GA 31557

Customer Information

Customer Name SS# --

Service Address

Drivers License Number If not Georgia, start with State. ex. FL F600-111-79-111-0

Date of Birth

Email Address

Phone Number Alternate Phone

Mailing Address - if different

Check one Own Rent

      If Rented: Landlords Name:

      Phone Number:

Have you ever had service with the City of Patterson ?

if yes, under what name?

** The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way; however, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.

Please Select One:

Select all services you receive: Water Sewer Garbage

Type in Full Name for Signature: Todays Date

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You can contact us by phone @ 912-647-5776
Or By Email: