Once you complete the form below, please submit it along with the required documents to the Water Revenue Bureau (WRB).

Save the completed form as a PDF file on your computer, or take a clear picture with your smartphone, and email it to wrb.contactintake@phila.gov.

Please include your name and address in the subject line.  A WRB customer representative will reply with the status of your application and further instructions.

You can also send your form and copies of documents by mail to:

City of Philadelphia
WRB Intake / CU – 3rd Floor
1401 John F. Kennedy Blvd.
Philadelphia, PA 19102

Or use the Intake Unit drop-off box, located at the lobby level of the Municipal Services Building:
1401 John F. Kennedy Blvd.

You can also bring in your application to our Northeast Philadelphia satellite office: 7522 Castor Ave., Philadelphia, PA 19152

If you have questions about how to complete or submit this form, call (215) 685-6300.