Forms and Policies

Please complete the form specific to your need and submit it to or
Printed forms can also be submitted at Sampson County Public Works Office, 827 Southeast Blvd. Clinton, NC 28328.

Bank Draft Form

Leak Adjustment

Lock Box Form

Water Service Application (Online)

Water Service Application (for print)
*Please download and complete the application, use "Email Form" button on the top right corner to submit the application. Select your email option, click the "Continue" button, your completed form will be attached in the email. The application is ready to be submitted.
Work Order


Water Tap General Procedures