Signup for Larena Water Billing System
Name of Applicant
Age
Civil Status
-- Select Civil Status --
Single
Married
Separated
Widowed
Divorced
Citizenship
Location Sketch
Street and Purok
Barangay
-- Choose your Barangay --
Bontod
Cangbagsa
Cang-alias
Helen
Nonoc
North Poblacion
South Poblacion
Sabang
Building Classification
-- Classification --
Residential
Commercial
Special Commercial
Special Case (Boats)
Special Case (Deliver to Residence)
Email Address
Contact Number
Username
Password
Must be 8+ characters with uppercase, lowercase, number, and special character (e.g., !@#$%^&*?)."
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