Start Residential New Service Application

Requested Start Date * +

Are you a *

Property Owner

Renter

Property Manager/Realtor

Primary Applicant's First Name *

Last Name *

Date of Birth * +

Last Four of Social Security Number/ Tax ID Number *

Valid Driver's License Number *

Service Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Do you wish to receive your bill through e-mail? *

Yes

No

Billing Address *

City *

State *

Zip Code *

Check all that apply.

Pool

Sprinkler System

Water Softener

How many people will be living in the residence? *

Secondary Applicant Information

Secondary Customer Name

Last Name

Date of Birth +

Last Four of Social Security Number/ Tax ID Number

Valid Driver's License Number

Phone Number

Email Address

Emergency Contact

First Name *

Last Name *

Phone Number *

Email Address *

Renter Only Section

Landlord/Owner Name

Last Name

Street Address

City

State

Zip Code

Phone Number

Email Address

Terms & Conditions

Chapter 22 Article VI. Sec 22-280 Cross Connection Control Program

Backflow Devises: The City of League City is responsible for protecting the drinking water supply from contamination or pollution which could result from improper private water distribution system construction or configuration. This serves as a notice to the customer of the restrictions in place to provide this protection. The City of League City enforces these restrictions to ensure the public health and welfare. Your acceptance of water services acknowledges that the City will do annual backflow inspections to any new or existing devices. If the customer fails to comply with the terms of the backflow requirements, the City of League City will either terminate service, properly install, test and/or maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement shall be billed to the customer. ***For more information on the Backflow devices, refer to Chapter 22 Article VI. Section 22-280 *

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Same Day Service or After Hours Service:

I understand that I may incur a fee if I am requesting for my services to be connected same day or after business hours. This fee will be present on my initial statement along with my deposit and connection fee. *

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Connection to Water:

I understand that the City will begin water service by making a physical connection from the meter to the outside of the residence. I understand that the City will not have access to personal property and will not determine if there are any open faucets or water system leaks on or in the property. *

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City of League City Sec. 114-121 Disconnection of Service for Nonpayment

I understand that I am responsible for paying my monthly bill on or before the due date. Under City of League City ordinance, If any water, wastewater, or solid waste charges are not paid within ten business days after the due date, such service may be discontinued. *

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Pursuant to Sec. 182.052. Confidentiality of Personal Information:

A government-operated utility may not disclose personal information in a customer's account record, or any information relating to the volume or units of utility usage or the amounts billed to or collected from the individual for utility usage, if the customer requests that the government-operated utility keep the information confidential. You may exercise your right for confidentiality by initialing below. *

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Red Flag Policy and Identity Theft

To attempt to prevent identity theft, The City of League City requires all applicants to provide a government issued picture ID, the last four digits of your social security or tax ID number, or similar documentation to establish utility services. Please note that additional documentation may be requested. *

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Copy of Primary Driver's License or Valid Government Issued ID *

Closing Disclosure, Settlement Page, or Rental Agreement *

Copy of Associated Customer's Driver's License or Valid Government Issued ID