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Request for Water Service

  1. Application for Water Service

    This form is an application for new water service with the City of Jesup. Upon submitting this form, you must present the following: Drivers License or State issued ID, a copy of your rental agreement or closing papers, and a Deposit of $125 and $40 Connection Fee. Any outstanding bills due must also be paid in full prior to new service. Upon completion of this form you must call City Hall at (912) 427-1313 or visit us at 162 E. Cherry Street in Jesup to complete payment for your service request. Service will not be connected until payment has been received.

  2. FOR COMMERCIAL ACCOUNTS, please list the name of the business if you would like the account listed under your business.
  3. Address of requested water service in Jesup
  4. Please enter date you would like service to begin. ****Note service is only connected on Mondays, Wednesdays, and Fridays.
  5. Address where bills should be mailed
  6. Type of Service Requested*
    Please select one:
  7. Property Type*
  8. Electronic Signature*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  9. Please type your first name. middle initial, and last name.
  10. A copy of your Drivers License or State issued ID, and a copy of your rental agreement or closing papers is required. Please mail to PO Box 427, Jesup, GA 31598, bring in person to City Hall (162 E. Cherry St. Jesup, GA 31546), or email the water department staff at,, or 

  11. Leave This Blank:

  12. This field is not part of the form submission.