Request Water Service

Are you Renting, Leasing, or Owning? * 🛈

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Service Request *
 Personal Information
First Name
Last Name
Phone Number
Service Request *
 Personal Information
Builder Name
Representative Name
Phone Number
Service Request *
 Personal Information
Company Name
Representative Name
Phone Number
Mailing Address *
 Mailing Information
Mailing Address
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Zip Code
When starting a Utility Account there is a $27.00 Account Maintenance Fee that will be charged on your first bill. This fee is a one-time charge and will not be on any bills following your first one. By checking the box below you are accepting that you understand and acknowledge this fee. *
By checking the box below you agree to the following terms: I agree that the information provided is accurate and that I am the individual associated with this information. I agree to submit this information to the City of Belmont in North Carolina and understand that this information will be used to start a Utility Account under the information I provided. I understand that I will be held financially responsible for any charges associated with starting this Utility Account with the City of Belmont in North Carolina. Should any of the information that I provided be found to be false, I will pay the associated fees and penalties to have this information corrected. *
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