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Residential Water-Sewer-Garbage Enrollment Form

  1. Renter or Owner*

  2. Garbage Service Type*

  3. Are you interested in more information on paying by auto draft from a checking account?*

  4. Electronic Signature Agreement*

    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. I/We hereby make application to the City of North Canton for utility service to said premises and hereby agree to pay all rentals and other charges for service at the due dates and to conform to all rules and regulations of the City of North Canton now or hereafter in force, pertaining to such utility service.

  5. Leave This Blank:

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