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2. Date*
   Date
3. Account Number*
5. First Name*
6. Last Name*
8. I approve the following changes to be made to my water service account with the City of Seaside:
10. Address
12. City
13. State
14. Zip Code
16. Email Address
17. Phone Number
18. Phone

    1. Cell
    2. Home
    3. Work
20. 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.

    1. I agree.
22. Electronic Signature*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field