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2. Commercial Application for Utility Service (Water, Sewer & Garbage)

4. Requirements for New 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). If you do not have a Texas issued DL or ID, Two (2) forms of ID will be required. 
   3. Initial deposit  required is determined by the Customer Service Department, based Upon the estimated water, sewer and garbage charges for two (2) months and the nature of the business. The minimum deposit required is $150.00. The deposit is set by City Ordinance.
   4. New Service will be activated the next City business day. A service initiation fee of $20.00 will be charged for same day service requests. All information must be provided prior to service activation. 

   The City will not initiate service if the meter indicates that water is running. An additional service fee of $15.00 will be charged for each subsequent trip to imitate service.

   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.

6. Note: Utility services to this address will not be furnished if you owe a delinquent bill at a previous or present address, or if all the required paperwork and information are not provided. Only the applicants will be allowed to make changes or inquire on this account. 

8. Service Start Date*
   Service Start Date
9. Renting or Owner:*
   -- Select One --RentingOwner
11. Billing Preference

    All bills will be emailed unless a paper bill is needed.

13. Email Address*
15. If you need a paper bill please select it below.

    1. Paper bill only
    2. Email bill only

17. Service Address:

19. Address*
21. City*
22. State*
23. Zip Code*

25. Mail Bill to:

27. Address*
29. City*
30. State*
31. Zip Code*
33. Business Name*
35. EIN #*
36. Driver's License #*

    (Copy of ID required or signatures notarized)

38. Upload Texas ID or Driver License*
39. Upload Texas ID or Driver License
41. Phone Number*
42. Cell Phone Number*
44. Manager*
45. E-Mail*
47. Owner*
48. E-Mail*

50. Contact information provided to the City will be used to notify residents in case of an emergency or public safety concern. You may view your emergency alert system preferences online at www.rosenbergtx.gov/alerts by registering for Nixle. 

    Certification: I hereby declare and affirm 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. 

52. 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.
54. Electronic Signature of Responsible Party

    (For Sole Proprietorship)

55. Date*
    Date
57. 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.
59. Electronic Signature of President or Duty Authorized Agent*

    On Behalf of Corporation

60. Date*
    Date

62. Automated Draft Information

64. Authorization for Automated Bank Draft Payments. If "Yes", Please upload a copy of voided check below.*
    -- Select One --Yes, I authorize the City of Rosenberg, Texas to initiate debit entries to my checking or savings accountI do not wish to participate at this time
66. Voided Check

    Please upload a copy of a voided check.

68. City of Rosenberg - Service Agreement

70. 1. 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. 
    2. Restrictions:The following unacceptable practices are prohibited by State regulations.
       1.  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. 
       2. 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. 
       3. No connection which allows water to be returned to the public drinking water supply is permitted. 
       4. 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. 
       5. 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. 
    3. Service Agreement: The following are the terms of the service agreement between the City of Rosenberg (the water System) and the applicant & Co-Applicants listed below (the customer)
       1. 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. 
       2. 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. 
       3. 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. 
       4. The Customer shall immediately remove or adequately isolate any potential cross-connections or other potential contamination hazards on his premises. 
       5. 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. 
    4. 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. 
72. 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.
74. Customer's Signature Electronic Signature*
75. Date*
    Date
77. Print Name*
78. Date
    Date

80. Commercial Garbage Request

82. Date*
    Date
83. Effective Date: *
    Effective Date:
85. Do you currently have a garbage cart:*
    -- Select One --YesNo
86. Request for garbage cart:*
    -- Select One --YesNo
88. Dumpster Request*
    -- Select One --YesNo
89. Lockable Dumpster:*
    -- Select One --YesNo
90. Dumpster Size*
92. Quantity:*
93. Times per week pick-up:*
94. Preferred days:*

    1. Monday
    2. Tuesday
    3. Wednesday

    1. Thursday
    2. Friday

96. Note: Containers will be delivered within 7-10 business days from date requested. Container requests submitted after 1:00 pm will not be submitted until the next business day. 

    Code of Ordinances, Sec. 23-31 (b) - Customers may not place carts in the street right-of-way for collection earlier than 12:00 p.m. (noon) the day before the day of collection and no later than 7:00 a.m. of the day of collection. Emptied carts must be removed from the street right-of-way no later than 8:00 a.m. on the morning following the day of collection. 

98. Connect With Us!

100. ​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
102. 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
104. 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.
106. Electronic Signature*
108. 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
110. 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
112. 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/DocumentCenter/View/742/Commercial-Policies-and-Procedures-PDF*

     1. I understand and agree
114. I understand that the water and garbage deposits will need to be paid before activation of services.*

     1. I understand and agree

116. 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.

118. 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.
120. Electronic Signature
Leave This Blank:


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

     This field is not part of the form submission.

124. Submit

* indicates a required field