Step 1 of 3 33% Account Number* Date* MM slash DD slash YYYY Account Holder First Last Service Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Drivers License Primary Secondary Date of Birth MM slash DD slash YYYY Email Primary Secondary Telephone Primary Secondary Account Information* Adding Account Information Removing Account Information New Account Holder Information: (If Applicable)Name on Account First Last Driver’s License/State ID Number: State Issued Photo ID UploadMax. file size: 50 MB.Please upload a state or federal photo ID. Date of Birth MM slash DD slash YYYY Email Address Phone NumberIf there is existing E-Bill information on the account, do you want it removed?* Yes No Would you like to set up E-Bill with a new E-mail address* Yes No Add E-Bill to E-Mail If there is existing Autopay information on the account, do you want it removed?* Yes No (If you want to set up autopay with new information, please complete a new autopay form. A voided check will be required.)If there is an existing Customer Portal Account, do you want it removed?* Yes No New Account Holder InformationProof of ownership is requiredI am the account owner for the property listed above, and I hereby request the change on this account as indicated above. Signature of NEW account holderPlease download (click here) the Declaration of Domicile for Purchase of Residential Utilities for exemption from Kentucky sales and use tax per KRS 139.470(7). After downloading, upload the executed document below, or alternatively you may email to newaccounts@hcwd2.orgDeclaration of Domicile Document UploadMax. file size: 25 MB.Please select a reason for change: Power of Attorney (Copy of POA documents are required) Adding/Removing of Account Holder Updating Account Information Legal Name Change/Marriage/Divorce (Legal Documents Required) Death (Death Certificate or Executor/Executrix Documents Required) Please be advised, forms received without required documentation and proof of property ownership will not be processed. EmailThis field is for validation purposes and should be left unchanged. Δ
