Customer Service Forms

Printable Forms

These forms need to be printed and signed.

• Request for Service Application - Request for new or transferred service. Please allow up to three (3) business days for processing. If submitting by email, please notate "New Service Request" in the subject line.
• Letter of Authorization - Request from the property owner authorizing prospective tenants.
• Termination of Service - Request to terminate service (Account Holder must request).
• Account Holder Contact Update - Request a change of mailing address.
• Automatic Debit (ACH) Agreement - Authorization to begin or terminate automatic payment from your checking or savings account.
• Relinquishing Deposits Authorization - Authorization to release the deposit to the new property/business owner.
• Residential Discount & Exemption Application - Request for exemption from late fees and/or a discount on garbage collection services (inside Cocoa city limits).

Online Forms

• Utilities Handbook - Information and policies for water utility customers.
• Utility Customer Public Records Exemption - Request for public records exemption.

• High Consumption Checklist - Checklist of common leaks/losses of water to aid the customer in leak detection.                 PDF English / Espanol

• High Consumption Credit Application - Request for high consumption credit.
• Utility Water Customer Contact Complaint - Complaint for water quality only; all other concerns please contact Customer Service.

Form Submission

Please submit completed and signed forms, with supporting documentation, to the City of Cocoa’s Water Customer Service Department in one of the following ways:

• Mail/Courier to:
  Water Customer Service Division
  65 Stone Street
  Cocoa, FL 32922
• Email signed and completed forms with documentation to customerservice@cocoafl.org. You will receive a response within three working days. If you do not receive a response in this timeframe, please contact Customer Service by phone.
  Please note: Florida has a very broad public records law (FS 119.01). As a result, any written communication created or received by the City of Cocoa Water Customer Service Division will be made available to the public and media, upon request, unless otherwise exempt. Under Florida Law, e-mail addresses are public record. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office.
• Visit our Water Customer Service Division at City Hall (65 Stone St. Cocoa, FL 32922) Monday through Friday during regular business hours.

Please note: If you submit an incomplete application or fail to submit all required documentation, processing of your application will be delayed.