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2. 
3. Utility Billing Department
   Transfer Application Request
   **Connection and disconnection within 19 days**
5. Current Address
7. Service Address*
8. Service Disconnection*
   Service Disconnection
   Service Connection only Monday-Friday. 24 HR notice is required. No service on holidays.
10. Additional Requests
12. Account Number*
16. New Service Address
18. New Service Address*
19. Connection Date*
    Connection Date
    Service Connection only Monday-Friday. 24 HR notice is required. No service on holidays.
21. Additional Requests:
23. Applicant Name*
25. Government issued PHOTO ID*

    Upload a copy of your ID.

27. Driver's License #*
28. Date of Birth*
    Date of Birth
30. Social Security #*
31. Phone #*
33. Email Address*
35. Secondary User (example: spouse or parent)
37. Mailing Address(if different than Service Address)
39. City
40. State
41. Zip
43. Billing Preference*
    -- Select One --Paper BillE-Bill
47. I AGREE TO THE FOLLOWING:*

    Please check all boxes below to comply.

    1. I understand that government issued PHOTO IDENTIFICATION is required for connection. A scanned copy or picture is fine.
    2. I understand I need to attach a copy of the rental lease agreement or buyers contract.
    3. I understand if the above dates should change and extend over 19 days, a transfer request cannot be completed. A new Residential Application will need to be created with a deposit paid up front.
49. Lease Agreement/Buyers Contract Upload
51. Service Agreement Contract
    Click here to view the Service Agreement Contract
53. Applicant Signature:*
    By typing your name you agree that you have read and understand the terms of the Service Agreement Contract.
55. We do not charge any Transfer Fees. The only requirement in order to transfer is that the current bill be paid. Please note that we bill a month behind therefore a final bill will be produced for the date of disconnection. Final bills are calculated around the 15th or 25th and due the 10th of the month. For your new location, you will receive your first bill once your meter has been read twice. We will take a 1st reading when you connect and read again during the monthly cycle reading for your route. We will mail your first bill towards the end of the month and the bill will be due the 10th of the month.
    
    
    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.
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57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

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