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Introduction
Personal Info
Service & Billing
Service Options
Required Documents


Thank you for your interest in submitting a request for water service.  To submit your request for water service, please complete this entire application.

There is a $50 connect fee.  The connect fee will be applied to the initial bill.



Please note that If you need to save this form and come back later to complete it, click the 'Save for Later' button below.  To resume the application, click the 'Resume Application' and provide the e-mail address and password you used to save the application.


YOUR INFORMATION IS SECURE


All information submitted in this form is protected and secured.

First Name:
Last Name:
Contact Phone #
Social Security #
DOB: (MM/DD/YY)
Type Of ID:  
State ID:
ID State:
Do you have e-mail address:  
Keep Information Confidential:  

Please complete this section with the applicant's personal information.


Keep Information Confidential

You can request that your personal information contained in our utility records not be released to unauthorized persons.

A change has been made by the Texas Legislature in the Open Records Act. This applies to Utility Billing only. This change gives you the right to request that your personal information (address, telephone number, or last 4 digits of your social security number) not be made available to the public.

We must still provide the information to:

  • An official or employee of the state or a political subdivision of the state, or the federal government acting in an official capacity
  • An employee of a utility acting in connection with the employee's duties
  • A consumer reporting agency
  • A contractor or sub-contractor approved by and providing services to the utility or to the state, a political subdivision of the state, the federal government, or an agency of the state or federal government
  • A person for whom the customer has contractually waived confidentially for personal information
  • Another entity that provides water, wastewater, sewer, gas, garbage, electricity. or drainage service for compensation.

Check 'Yes' if you want to exercise your right to keep your information confidential.

Street:
City:
State:
Zip:
Is Billing Address same as Service Address?  
Street:
City:
State:
Zip:
Address Verification:

Please complete this section with the requested connection date and the service and billing information.


Please note that we offer next business day service (excluding holidays).  For example, if you order your service on Friday, the next available connect date will be on the following Monday unless it is a holiday.

 

NOTE:  It is the responsibility of the customer to notify the Water Business Office of any changes (i.e., change of e-mail address, phone number, or mailing address).

Enroll in E-Bill?  
Enroll in bank draft (auto pay)?  

Please complete this section with the desired service options.

 

NOTE:  If enrolling in E-Bill, failure to receive your electronic bill does not exempt you from your service being interrupted if the account becomes past due.

 

It is the responsibility of the customer to notify the Water Business Office of any changes (i.e., change of e-mail address, phone number, or mailing address).


Please scan the following required documents and upload:
Social Security Document:
StateID Document:
Proof of Address Document:
 

alternative content

To complete your application, certain documents are required for verification purposes.  Please click the upload button for the specific document that is required.

Save for Later
If you need to save this form and come back later to upload the documents, click the 'Save for Later' button below.  To resume the application, click the 'Resume Application' and provide the e-mail address and password you used to save the application.

Please provide your e-mail address and password. You can resume the form later on by clicking on 'Resume Application'
E-mail Address:
Password:
Confirm Password:
 
 
Copyright 2017 by City of Tyler