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2. Customer Information
4. Eligibility

   To use the subsidy, the homeowner must:

   • Live within the City’s water service area.
   • Replace the privately owned portion of the service line (curb to meter).
   • Hire a licensed plumber/contractor to complete the work.
   • Pay the full cost up front.
   • Provide a detailed invoice showing plumber’s name, business address, and description of work.
   • Ensure work complies with city plumbing and utility standards.
6. Name*
8. Service Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number
15. Email Address
17. Billing Address (if different from Service Address)
19. City
20. State
21. Zip Code
23. Service Line Replacement Details
25. Date of Work Completed*
    Date of Work Completed
27. New Service Line Material
    -- Select One --CopperPlasticHigh-Density Polyethylene (HDPE / PE)PVC (Polyvinyl Chloride)
29. Licensed Plumber/Company Name*
30. Plumber’s Phone Number*
32. Plumber’s Business Address*
34. City*
35. State*
36. Zip Code*
38. Required Documentation (must be attached)
40. Service Line Replacement Invoice*

    Submit a Copy of original plumber’s invoice showing:

    •  Business address and telephone number
    •  Description of the work performed
    •  Material type of new water service line
    •  Proof of payment in full
42. Any Additional Comments?
44. Customer Certification

    I certify that the information provided is true and correct, and that I have replaced my privately owned service line (from the curb stop to the water meter) at my own expense. I understand that reimbursement is subject to review and approval by the City of Wilmington.

46. Signature*
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field