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1. 90 Day Application for Utility Services (Water, Sewer & Garbage) This section is complete This section is incomplete
2. Step Two This section is complete This section is incomplete
3. Applicant Information This section is complete This section is incomplete
4. City of Rosenberg, Texas Disconnect Authorization This section is complete This section is incomplete
5. City of Rosenberg Service Agreement This section is complete This section is incomplete
6. Connect With Us! This section is complete This section is incomplete
7. Acknowledgements This section is complete This section is incomplete

90 Day Application for Utility Services (Water, Sewer & Garbage)

Requirements for 90 Day Temporary Service
1. A completed application
2. One (1) form of identification from applicant(s). Must be a valid Texas driver's license (DL) or a photo ID card issued by the Texas Department of Public Safety (DPS).
3. If you do not have a Texas issued DL or ID, Two (2) forms of ID will be required.
You may email documentation to customerservice@rosenbergtx.gov or there is an "file upload" feature towards the end of the application. Once we have received and reviewed your application and documentation, one of our customer service representatives will contact you to pay the deposit over the phone. If you have any questions regarding your application, you may call our Customer Service Department at 832-595-3400 during normal business hours or you may email them at customerservice@rosenbergtx.gov.
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Step Two

Service Start Date*
Service Start Date
Note: New Service activation will be processed the next business day. For same day service requests, a service initiation fee of $20.00 will be charged. Application and related documents must be received before 4:30pm if requesting same-day service. Water service connection can only be accommodated on weekdays. The City is unable to start water service on weekends or holidays.
Please indicate if you are:
Landlord Name & Phone Number*
Only required if you are renting/leasing, otherwise if not applicable, please put "N/A" as your answer.
Service Address*
Street Address
City
State
Zip Code
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Applicant Information

Applicant Name*
First and Last Name
Mailing Address
If different from Service Address
City
State
Zip Code
Home Phone
Cell Phone*
Email*
Would you like to enroll in e-Bill services and receive your monthly bills via email? Note: By selecting "Yes", you will not receive a paper copy*
1. Yes (please note the monthly bills will be emailed to the email address entered above)
2. No
Employer*
Phone Number*
Date of Birth*
Date of Birth
Photo ID
Please upload a copy of your Driver's License or Identification Card.
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City of Rosenberg, Texas Disconnect Authorization

The account holder listed below, authorize the City of Rosenberg to disconnect my utility services at the below listed property address on the specified date and mail my final bill to the below listed Forwarding address.
Service Address
Address*
City*
State*
Zip Code*
Final Date*
Final Date
90 Day maximum
Forwarding Address
Address*
City*
State*
Zip Code*
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date
Date
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City of Rosenberg Service Agreement

I have read and agree to the terms listed in the following service agreement between myself and the City of Rosenberg.*
1. I agree
I. Purpose: The City of Rosenberg is responsible for protecting the drinking water supply from contamination or pollution which could result from improper private water distribution system construction or configuration. The purpose of this service agreement is to notify each customer of the restrictions to ensure the public health and welfare. Each customer must sign this agreement before the City of Rosenberg will begin service. In addition, when service to an existing connection has been suspended or terminated, the water system will not re-establish service unless it has a signed copy of this agreement. II. Restrictions: The following unacceptable practices are prohibited by Sate regulations. A. No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air-gap or an appropriate backflow prevention device. B. No cross-connection between the public drinking water supply and a private water system is permitted. These potential threats to the public drinking water supply shall be eliminated at the service connection by the installation of an air-gap or a reduced pressure-zone backflow prevention device. C. No connection which allows water to be returned to the public drinking water supply is permitted. D. No pipe or pipe fitting which contains more that 0.25% lead may be used for the installation or repair of plumbing at any connection which provides water for human use. E. No solder or flux which contains more than 0.2% lead can be used for the installation or repair of plumbing at any connection which provided water for human use. III. Service Agreement: The following are the terms of the service agreement between the City of Rosenberg (the Water System) and the Applicant & Co-Applicant's Printed Name A. The Water System will maintain a copy of this agreement as long as the Customer and/or the premises is connected to the Water System. B. The Customer shall allow his property to be inspected for possible cross-connections and other potential contamination hazards. These inspections shall be conducted by the Water System or its designated agent prior to initiating new water service; when there is reason to believe that cross-connections or other potential contamination hazards exist; or after any major changes to the private water distribution facilities. The inspections shall be conducted during the Water System's normal business hours. C. The Water System shall notify the Customer in writing of any cross-connection or other potential contamination hazard which has been identified during the initial inspection or the periodic re-inspection. D. The Customer shall immediately remove or adequately isolate any potential cross-connections or other potential contamination hazards on his premises. E. The Customer shall, at his expense, properly install, test, and maintain any backflow prevention device required by the Water System. Copies of all testing and maintenance records shall be provided to the Water System. IV. Enforcement: If the customer fails to comply with the terms of the Service Agreement, the Water System shall, at its option, either terminate service or properly install, test, and maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement of this agreement shall be billed to the Customer. For information regarding water quality and FAQs, visit https://www.rosenbergtx.gov/water-disinfection nd https://www.rosenbergtx.gov/water-faqa
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Connect With Us!

Sign up for notifications regarding utility services (water outages, boil water advisory, delinquent notices, etc...)*
1. Text
2. Phone
3. I would not like to receive notifications
The City has a new emergency notification system! Please select any or all below types and stay informed of trusted neighborhood public safety and community information.*
1. RTOWN for City related notifications
2. RPDALERTS for Police related notifications
3. RFDALERTS for Fire related notifications
4. REVENTS for City Special Event notifications
5. I would like to receive ALL notification types
6. I would not like to receive any notifications
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Acknowledgements

I understand that the City requires a one working day notice to connect service. If same-day service is required, a $20 service initiation fee will be charged.*
1. I understand and agree
I understand that the City will not initiate service if the meter clearly indicates that water is running. There is a $15 charge for each subsequent trip to initiate service.*
1. I understand and agree
I understand and have read the policies and procedures for residential service. The policies and procedures document may be found on the 'Forms' page of the Utility Services page at https://rosenbergtx.gov/forms-utility-services/*
1. I understand and agree
I hereby declare and affirm, by 'signing' my name(s) below, to the best of my knowledge and belief, all statements and answers as stated herein are full, complete, and true. I, the undersigned, fully understand that I am responsible to pay for utility service or other charges which may become due to the City of Rosenberg at this address. All persons who sign this application shall be jointly and severally liable for any water, sewer, and garbage service charges incurred at this service address.*
Please type in your name as your "signature"

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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90 Day Temporary Application for Water and Sewer Service

Steps

90 Day Application for Utility Services (Water, Sewer & Garbage)

Step Two

Applicant Information

City of Rosenberg, Texas Disconnect Authorization

Service Address

Forwarding Address

City of Rosenberg Service Agreement

Connect With Us!

Acknowledgements

Contact Us

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