New Water Service Application – Residential Only

Property Information

Date to Start Water Service(required)

Service Address(required)

Mailing Address(required)

Please indicate if you are:(required)

How many people are living in the home?(required)

Customer Information

Customer Name(required)

Date of Birth(required)

Social Security Number(required)

Driver's License Number(required)

Phone Number(required)

Email Address(required)

I want to receive e-notifications for my water bill.

Employer(required)

A Spouse/Other will occupy the home as well.

Spouse/Other Information

Spouse/Other Name(required)

Spouse/Other Employer(required)

Spouse/Other Date of Birth(required)

Spouse/Other Driver's License Number(required)

Spouse/Other Social Security Number(required)

Landlord Information

Landlord's Name(required)

Landlord's Address(required)

Landlord's Phone Number(required)

Curbside Recycling

I'd like to enroll in the curbside recycling service.

Thank you for your interest in the City of Beaumont’s curbside recycling program. Participation in the program is available to all residents of the City of Beaumont on a volunteer basis. Recycling collection will occur once per week on your current trash pickup day.

All “allowable materials” must be placed in the recycling container and placed at the curbside in order to be collected by the City of Beaumont.

I accept and agree to be charged a recycling container fee of $58.00 and a recycling service fee of $11.50 per month.

Attachments

Copy of Driver's License with photo for each person listed on account.(required)

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Maximum size of 50MB

Copy of Closing Papers(required)

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Maximum size 50MB

Copy of Lease Agreement(required)

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Maximum size 50MB

Bank Draft

I want to enroll in direct payment.

Financial Institution Name(required)

Financial Institution Phone Number(required)

Financial Institution Address(required)

Routing Number(required)

Account Number(required)

Name as Shown on Account(required)

Type of Account(required)

Checking

Savings

Copy of Voided Check(required)

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Maximum size 50MB

Note: Continue to pay by check/cash until your bill says "DO NOT PAY."

Legalese

I understand that the City will begin water service by making a physical connection located outside the building or buildings to be served. I understand that the City will not have access to any building served and will not determine if there are any open faucets or water system leaks inside the building. If there are any open faucets or water systems leaks that cause damage to the property, I agree not to hold the City responsible for any damages arising therefrom.

I understand that the City requires a minimum of one working day notice to connect service.

I understand a deposit of not less than $125 is mandatory to establish a new account. A service fee of $15 is also due when setting up new service.

I understand that the City will not initiate service if the meter indicates water is running.

I want my address, telephone number and Social Security number to be kept confidential.

Applications received by 4:00PM, Monday through Friday, will have water service started the next business day by 5:00PM. Applications received after 4:00PM or on the weekend will have service started within two business days by 5:00PM.

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