Forms

The forms listed below are available in PDF format for customers to download, fill out and print for return to ECUA by mail, fax, or in person at our Ellyson Customer service office. Customers should contact an ECUA Customer Service Representative at (850) 476-0480 to ensure that they are using the correct form required for their particular need.

Agreement for Grinder Pump Station

Application for Reimbursement of Grinder Pump Station

Capacity Impact fee Agreement and Notice of Lien

Capacity Impact fee agreement form

Customer Information for Low Pressure Sewer Systems

Decrease Meter Request Form

ECUA Sanitation & Recycling Service Selection Form

FOG Permit Application

Indemnification Bond Form

Irrevocable Letter of Credit Form

Irrigation Meter Agreement Form

Large Meter Contract

Lease Date Verification Form

New Service Information Form

One-Time Leak Adjustment Agreement Form

Power of Attorney Form

Pre-Authorized Checking Form

Project EUAP (Escambia Utilities Assistance Program) Contribution Form

Relinquish of Deposit Form

Removal of Service Request Form

Request for Service Requirements

Request for Single Service connection

Sanitation Release Form

Supplemental Security Income (SSI) Discount Form

Temporary Water Service Agreement Form (Connection to a Fire Hydrant)

Unexplained Water Loss Adjustment

Utility Deposit Guaranty Agreement Form

Variance Application Form