Release of Liability for Water Service Reconnection

Release of Liability For Water Service Reconnection
To prevent water damage, always turn off your main water valve or all faucets and hose bibs before water service is restored.

I do release and discharge WSSC and its employees from all claim,damages and causes of action which may arise from the turning on of water service at the following property:
Date

MonthDayYear
Date
Of the property set forth, I am the
Account Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PLEASE READ BEFORE SIGNING. THIS IS A RELEASE.
By selecting this box, I am submitting this form with my electronic signature:
Print Full Name: Owner/Tenant/Authorized Agent
Signature: Owner/Tenant/Authorized Agent
Daytime Phone Number
Email
example@example.com
* If New Owner/Tenant; Please Fill in Required Information *
Driver’s License #
Title Company/Settlement Attorney Name (Property Owner Only)
Title Company/Settlement Attorney Address (Property Owner Only)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Meter Reading(s)
Main Meter Reading (Inside)
Outside Remote Reading Device (if possible)
Sub-meter Reading (if applicable)
Outside Remote Reading Device (if possible)
If your water meter is located outside, WSSC Water personnel will read your meter when service is reconnected.

Call 301-206-4001 to confirm the release was received.
14501 Sweitzer Lane, Laurel, MD 20707
www.wsscwater.com

Main: 301-206-9772
Emergency: 301-206-4002
Customer Service: 301-206-4001
Toll-Free: 800-828-6439
TTY: 301-206-8435
Should be Empty:

Release of Liability For Water Service Reconnection

PLEASE READ BEFORE SIGNING. THIS IS A RELEASE.

* If New Owner/Tenant; Please Fill in Required Information *

Meter Reading(s)