Online Service Agreement

Please fill out the online application for the new service, and make sure you read and understand the "terms of the agreement."

Please make sure all information is filled out correctly, then click submit. Please note: applications will not be accepted, or water service will not be turned on without all requested information.

Once we receive your application, please allow 24 hours for us to process it. Once the application is processed, a BRWA representative will contact you with a deposit amount and any other associated fees.

All fees are due at that time before any service can be provided. Water service can only be started Monday-Friday.

If you are renting, you must provide a rental agreement before the service can begin. You must also provide a copy of a driver's license or government-issued identification. Rental agreements and proof of identification can be emailed to service@ncbrwa.com or faxed to 877-375-1630.

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Applicant Name: *

(Legal Name)

Service Address

Address: *

City: *

State: *

Zip Code: *

Billing Address

Address: *

City: *

State: *

Zip Code: *

Contact Information

Primary Phone Number: *

Secondary Phone Number

Email Address: *

Spouse's Name:

Spouse's Phone Number:

Contact Name: *

(If Applicant Name above is a Business Name)

Building Type *

(Note that lease or proof of rental must be provided)

Renter's Landlord Name: *

Landlord's Phone Number: *

Date Requested to Start New Service

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Type of Customer: *

Current or Prior, enter Service Address: *

If disconnect requested on current address, enter disconnect date requested:

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Statement of Agreement

This agreement, when signed by the customer and BRWA representative is a contract under which BRWA agrees to furnish water and the customer agrees to pay for such service in accordance with applicable rates and fees, and abide by the terms of service. If applicable, customer will be billed by BRWA for sewer and/or sanitation services furnished to customer by the Town of Rutherfordton, Town of Spindale, of Cliffside Sanitary District, in accordance with applicable rates, fees, and terms of service established by the respective entities. There is no outstanding delinquent debt for utility services, fees, or penalties due to BRWA, under an agreement, written or implied, made by me or another person who is now or has been a member of my household or who resides at the above address, and I am responsible for the payment of all utility service charges at this address and for conformance with the terms of this agreement and all policies of BRWA. I agree that BRWA has the right to enter upon my property for the purpose of maintaining and operating its facilities and may exercise the right to discontinue services and remove its facilities in case of violation of any of the terms of this agreement or if any of the information I have provided is found to be incorrect. Unclaimed funds of $10 or less that remain on a customer account for a period of one year will be forfeited to BRWA as a dormancy charge, effective July 1, 2023. Unapplied deposit funds of less than $25 will not automatically be refunded by check unless requested by customer.
*Disclosure of SSN is voluntary and will be used for collection of delinquent balances to the North Carolina set-off debt collection program and/or a third part collection agency.

Initials: *

Enter Your Legal Name as a Digital Signature and click Submit: *