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2. 
3. Utility Billing Department

   Residential Service Application

5. Service Address*
7. Connection Date*
   Connection Date
   Service Connection only Monday-Friday. 24 HR notice is required. No service on holidays.
9. Additional Requests
11. Applicant Name*
13. Government issued PHOTO ID*

    Upload a copy of your ID.

15. Driver's License #*
16. Date of Birth*
    Date of Birth
18. Social Security #*
19. Phone #*
21. Email Address*
23. Mailing Address(if different than Service Address)
25. City
26. State
27. Zip
29. Billing Preference*
    -- Select One --Paper BillE-Bill
31. Secondary User (example: spouse or parent)
33. Are you a new Brownwood resident?*

    1. Yes
    2. No
35. Lease Agreement/Buyers Contract Upload
37. I AGREE TO THE FOLLOWING:*

    Please check all boxes below to comply.

    1. I understand that I must pay the Utility Billing Deposit based on meter(s) size by contacting Utility Billing at (325)646-9700.
    2. I understand that government issued PHOTO IDENTIFICATION is required for connection.
    3. I understand that with my submission I am responsible for payment of the account.
    4. I understand I need to attach a copy of the rental lease agreement or buyers contract.
    5. I understand the terms of the Service Agreement Contract.
    6. I have reviewed and understand the Bill Information Sheet.
39. Bill Information Sheet
    Click here to view the Bill Information Sheet
41. Service Agreement Contract
    Click here to view the Service Agreement Contract
43. Please remember to call our Utility Billing office at 325-646-9700 for payment of deposit for completion of application. Thank you!
45. Applicant Signature:*
    By typing your name you agree that you have read and agree to the terms and conditions of the Service Agreement Contract in the link provided above.
47. The City of Brownwood water utility strongly suggests that you close the private customer gate valve prior to the City arriving to restore service to this address. The City will not be responsible for damages to the property or inside the home due to any water leak or open lines upon or after the City restores service.
Leave This Blank:


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

    This field is not part of the form submission.

51. Submit

* indicates a required field