Water, Sewer, Solid Waste Application

Water, Sewer, Refuse Application

DO NOT USE THIS APPLICATION FOR NEW CONSTRUCTION.
APPLICATIONS WITHOUT LEGIBLE SIGNATURES WILL BE REJECTED
Applicant Information
ResidentialBusinessOther
Full Name*

First NameLast Name
Home Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Work Phone*

Area CodePhone Number
Employer*
Email*
example@example.com
License/ID Number*
License/ID State*
Date of Birth*

MonthDayYear
Date
Please Upload a Photo of your Government Issued ID*

Browse Files

Cancelof
If the new service is non-residential:
Entity Name
Tax ID #
YesNo

Spouse or Roommate

If Applicable
Spouse/Roommate Name

First NameLast Name
Spouse/Roommate Home Phone

Area CodePhone Number
Spouse/Roommate Cell Phone

Area CodePhone Number
Spouse/Roommate Work Phone

Area CodePhone Number
Spouse/Roommate Employer
Spouse/Roommate Email
example@example.com
Spouse/Roommate License/ID Number
Spouse/Roommate License/ID State
Spouse/Roommate Date of Birth

MonthDayYear
Date

Service Application

A NEW SERVICE FEE WILL BE ADDED TO YOUR FIRST BILL
We do not offer same-day service. Please allow at least 2 business days for service to begin. Customers submitting applications online will receive an email confirming when service will begin.
Begin Service On (Monday through Friday ONLY)*

MonthDayYear
Date
Choose a Service Time*
Service Address*

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Mailing Address*

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Previous Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
If yes, when? (Monday through Friday ONLY)*

MonthDayYear
Date
Parks Bucks

Parks Bucks are donations specifically designated for parks & recreation improvements.
YesNo

Waiver of Liability
YesNo

Waiver of Liability

I would like my water turned on when I am not at home.
Comments about Water Turn-On
Problems may occur when water is furnished at the beginning or after a disruption of service. The City of Abilene has a policy against turning on water service when no one with control of the property is present. For instance, a pipe inside a residence/building may be broken and start to leak when the water is turned on. City utility workers outside the residence/building cannot know this, and damage may result.

Understanding the policy stated above, I, as the lessee or owner of the property, request that water be turned on at the above address even though no one will be on the premises. In return for the City's special consideration in granting an exception to its policy stated above, I agree to hold the City of Abilene harmless and waive any claims against the City or its employees for damages which may occur when water service is furnished due to leaks, faulty plumbing, open taps and the like in said building. I take full responsibility for any damage which may result when the water service is furnished.
Signature*
Date*

MonthDayYear
Date

Request for Confidentiality of Personal Information
YesNo

Request for Confidentiality of Personal Information

I would like to keep my personal information confidential.
Request for Confidentiality of Personal Information Maintained by the City of Abilene Water Utilities Department

Personal information in your City of Abilene Water Utilities Department customer account records (e.g., your address and telephone number) is generally considered public information under the Texas Government Code, Chapter 552 (Public Information Act). The social security number of a living person is confidential and may not be released in most cases.

The Texas Utilities Code, Chapter 182 (Rights of Utilities Customers), provides that a government-operated utility may not disclose personal information if the customer requests that the government-operated utility keep the personal information confidential.

*A request for confidentiality under Chapter 182 does not prohibit a government-operated utility from disclosing personal information in a customer’s account record to: (1) an official or employee of the state, political subdivision of the state, or the United States acting in a official capacity; (2) an employee of a utility acting in connection with the employee’s duties; (3) a consumer reporting agency; (4) a contractor or subcontractor approved by and providing services to the utility, the state, a political subdivision of the state, or the United States; (5) a person for whom the customer has contractually waived confidentiality for personal information; or (6) another entity that provides water, wastewater, sewer, gas, garbage, electricity, or drainage service for compensation. A customer may rescind a request for confidentiality by providing the government-operated utility written permission to disclose personal information. A government-operated utility or an officer or employee of a government-operated utility is immune from civil liability for a violation of Texas Utilities Code, Subchapter B.

This form enables you to request confidentiality of your personal information under Texas Utilities Code, Chapter 182. If you wish to request confidentiality of your personal information, please check the box below.
YesNo
Request for Confidentiality Signature*
Request for Confidentiality Date *

MonthDayYear
Date

Bank Draft Authorization
YesNo

Bank Draft Authorization

I would like to pay my monthly utility bill by bank draft.
Bank drafts draw electronic payment on your bank account each month for your monthly utility bill. You will still receive a bill by mail or email as requested.

Please complete and sign this form. You can also attach a voided blank check. If you have any questions concerning drafts, please call our office at (325) 676-6405.
- Please allow 4-6 weeks for the bank draft to take effect
- Continue to pay your bill as usual until the bill indicates “Paid by Draft”
- The draft(s) will be drawn on the due date(s) indicated on your bill(s)
- The City of Abilene reserves the right to immediately discontinue this service to my utility account(s) should an issue arise from its use
- I may discontinue the use of this service at any time, allowing ten (10) business days from receipt of my request for it to take effect
Name on Bank Account*
Name of Bank
Bank City, State

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Checking AccountSavings Account
Bank Routing #*
Confirm Bank Routing #*
*Bank Routing Number & Confirm Bank Routing Number must match
Bank Account #*
Confirm Bank Account #*
*Bank Account Number & Confirm Bank Account Number must match
Please attach a voided check to complete the bank draft process.

Browse Files

Cancelof
If you have more than one account, please list each account separately.
Water Account Address #1

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Water Account Address #2

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Water Account Address #3

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Water Account Address #4

Street Address

Unit Number

CityState / Province

Postal / Zip Code
With my signature below, I authorize the City of Abilene Water Utility Office to draft the bank account listed above for the utility services on the accounts designated on this form until otherwise revoked.
Signature*
Date*

MonthDayYear
Date

E-Mail Billing Agreement
YesNo

E-Mail Billing Agreement

I would like to receive my monthly utility bill by email.
Email*
example@example.com
I acknowledge that:
- My Regular Water Billing Notices and Late/Disconnect Notices will be sent via email. It will be my responsibility to contact the Water Utility Office if I have not received my monthly water bill.
- The City of Abilene Water Utility Office will discontinue sending a paper bill to my billing address.
- I will not receive inserts that are periodically included in water bills, but information on how to obtain them will be available by contacting the Water Utility Office.
- It is my responsibility to ensure that the email address on record at the Water Utility Office is current.
- I may discontinue the use of this service at any time in writing, allowing ten (10) business days from receipt for my request to take effect.
- Because of the nature of email, there is no expectation of privacy. And should any information contained within my emailed utility bill be intercepted and/or viewed by an unauthorized party the City of Abilene is released from any liability.
- The City of Abilene will not provide my email address or personal information to any outside entity except as required by law.
- The City of Abilene reserves the right to discontinue this service to my water account(s) should an issue arise from its use. Should this occur, the Water Utility Office will resume mailing paper bills to the billing address listed on my account.
I would like the email address used on my City of Abilene water account(s):
Water Account Address #1

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Water Account Address #2

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Water Account Address #3

Street Address

Unit Number

CityState / Province

Postal / Zip Code
Water Account Address #4

Street Address

Unit Number

CityState / Province

Postal / Zip Code
With my signature below, I understand and accept the terms and conditions of this electronic billing agreement as listed above.
Signature*
Date*

MonthDayYear
Date

Finalize Application
With my signature below, I accept responsibility for payment of utility bills, and agree to abide by all rules & regulations governing services, which are established by the City Council of Abilene. Failure to comply may result in a termination of services.

And, I authorize the City of Abilene to contact me via current and future cellular phone number(s), email address, or wireless device regarding my delinquent account(s) owed to the City of Abilene. I authorize its agents, representatives, and attorneys (including collection agencies) to use automated telephone dialing equipment, artificial or pre-recorded voice or text messages and personal calls and emails, in their effort to contact me for purposes of collecting any portion of my account which is past due.
Signature*
Today's Date*

MonthDayYear
Date
View the Water Utility Department's Schedule of Rates & Charges (link will open in a new window)
Should be Empty:

Water, Sewer, Refuse Application

Applicant Information

Spouse or Roommate

Service Application

Parks Bucks

Waiver of Liability

Waiver of Liability

Request for Confidentiality of Personal Information

Request for Confidentiality of Personal Information

Bank Draft Authorization

Bank Draft Authorization

E-Mail Billing Agreement

E-Mail Billing Agreement

Finalize Application