Forms – City of Benton

City applications, made easier. Download a fillable PDF to save or print, or complete an application online for the City Clerk.

Online submissions are requests for city review. Fees, original signatures, notarization and department approval may still be required. Downloaded PDFs include the unmodified original forms as reference pages.

← All city forms

Application for New Water Service

If outside city limits, the original requires a signed and approved annexation agreement before service. The original responsibility statement is included in the reference pages. Supply identity numbers directly to City Hall; do not email them.

Download fillable PDF

Privacy: Do not enter or upload Social Security numbers, driver license numbers, identity cards, birth dates or payment card details. Supply identity information directly to City Hall.

How can staff contact you?

Contact name *

Email *

Phone

Applicants

Applicant

Co-applicant

Phone

Address for service

Applicant employer

Applicant employer phone

Co-applicant employer

Co-applicant employer phone

Service and property

Had Benton service before?

If yes, when?

Previous unpaid city bill?

If yes, how much?

Inside Benton city limits?

Mobile home?

Rent or own

Property owner name

Property owner address

Property owner phone

Date service requested

Responsibility and signatures

Name accepting responsibility for water and sewer bills

Applicant signature / typed name

Applicant signature date

Co-applicant signature / typed name

Co-applicant signature date

Supporting documents (optional)Up to 3 PDF, JPG or PNG files; maximum 2 MB each.

Use for plans and other supporting documents. Do not upload identity documents or documents containing sensitive identity numbers. For larger plans, contact City Hall.

I am submitting this information for city review. I understand that submission does not grant a permit, start utility service or replace required original signatures or notarization.

The site saves your application privately and emails it to cityclerk@bentonil.gov.