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2. Effective Date*
   Effective Date
   Enter the date for this change to take effect.
4. Your Email Address*
6. Current Name on Account*
   Please enter the name currently on the account.
8. Account Number*
   Please enter the BWA account number.
10. Service Address*
    Please enter the service address
12. Account Holder ID*
    Please upload a copy of the current account holder's valid government-issued photo ID.
14. Additional Account Holder*
    Please enter the name you would like added to this account. For rental properties, only names of persons listed in the rental agreement may be added to the water account.
16. Additional Account Holder ID
    Please upload a copy of the additional account holder's valid government-issued photo ID.
18. Rental Properties
    If this is a rental property, we may request a copy of the current lease, which must include the name of the additional account holder. A BWA representative will contact you if this is needed.
22. Electronic Signature Acknowledgement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your Name Change Request 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.

    1. I agree
24. Electronic Signature*
    Enter your name.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field