Western Monmouth Utilities Authority

103 Pension Road, Manalapan, NJ 07726
(732) 446-9300



Account No:

(Above to be completed by W.M.U.A. Clerk)

Please fill in all information below:

Date of Closing/Connection:

Property Address: (Address Line 1)
(Address Line 2)



(Zip Code)




Owner's Address: (Address Line 1)
(Address Line 2)
(State) (Zip Code)

Development Name (if applicable):

Phone Number:

The premises to be served are classified as:
Single Family

If other than above, please explain:

Email Address:

The undersigned hereby makes application to the Western Monmouth Utilities Authority for sewer service at the premises described above beginning the above date. In making this application, the undersigned agrees to abide by the Rules and Regulations of the Authority, a copy of which is kept at the Authority's office and is available for examination upon request during normal business hours. It is acknowledged that the discharge of surface or ground water from sump pumps, cellar drains, gutters or area drains is not permissible. The undersigned further agrees to give the Authority ten (10 ) days' written notice of his intention to sell the above property, furnishing the Authority with the full name of the new owner, that he will settle with the new owner any adjustment on prepaid sewer charges. Notwithstanding any agreement between the owner of the subject premises and the occupant of the subject premises, the service charges are the responsibility of the owner of the property. Failure to pay same when due will subject the property to foreclosure and sale as in any case with any taxes due on realty.

The present annual rate for sewer service is per Equivalent Domestic Consumer Unit (EDCU). The number of EDCU's assigned to a property is based on W.M.U.A. Rules and Regulations.

TERMS OF PAYMENT: The annual rate for service shall be due quarterly in advance on the 25th day of the month of billing. Initial bills for new connections shall be pro-rated. Bills are due and payable in full, without discount. Interest of 1.5% per month will be charged on the unpaid balances at month-end.

Electronic Signature Disclosure and Consent Statement

You consent and agree that your use of a key pad, mouse or other device to select an item, button, icon, check box, to enter text, or to perform a similar act/action, while using the Western Monmouth Utility Authority's secure forms, for the purpose of accessing or making any transactions regarding any agreement, acknowledgment, consent, terms, disclosures or conditions, constitutes your signature, acceptance and agreement as if actually signed by you in writing.

You further acknowledge and agree that the taking of any such actions by you evidence your intent to sign any such agreement, acknowledgment, consent, terms, disclosures or conditions.
You also agree that no certification authority or other third party verification is necessary to the validity of your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or any resulting contract.

I, the applicant for/on this Contract for Sewer Services, warrant the truthfulness of the Information provided in this application.

(Required) Please type owner's Legal First and Last Name below *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree that I have typed my name and checked the box myself. *
(Required) Check box to submit your electronic signature

Accepted the day and year first above written

Western Monmouth Utilities Authority