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If you have additional documentation relating to this application, please email to firstname.lastname@example.org and include your name, account number, and phone number, if this information is not included in the email, processing of your application will be delayed.
Please upload legible copies of repair receipts.
Pool/Landscape option is for a sewer credit for Cocoa Residents on Cocoa Sewer ONLY. All other customers outside the City of Cocoa's sewer system must consult the appropriate sewer utility for a sewer credit. No water credit is given on pool fills or landscape improvements.
By typing my name in this form, I affirm the accuracy of information provided on this application. I understand that this constitutes a legal signature and confirms that I agree to the above terms.
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