Service Application
Step
1
of
3
33%
Applicant Name
(Required)
First
Last
Spouse's Name
First
Last
Physical Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Different Billing Address
My billing address is different than physical address
Billing Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
(Required)
Alternate Phone
Email
(Required)
Paper Bill Request
Click below if you want a physical bill, otherwise your bill will be emailed monthly.
Yes, I would like a paper bill.
Property Status
(Required)
Choose one below
Rent
Own
Previous Owner Name and Address
ONLY IF KNOWN
Drivers License
(Required)
Please submit a copy (front and back) of your valid drivers license.
Max. file size: 499 MB.
Proof of Ownership or Lease Agreement
(Required)
Please upload proof of ownership or current lease agreement.
Max. file size: 499 MB.
Requested Information
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
Ethnicity
Hispanic or Latino
Not of Hispanic or Latino
Race
White
Black or African American
American Indian/Alaska Native
Asian
Native Hawaiian or other Pacific Islander
Gender
Male
Female
Service Application and Agreement
(Required)
This AGREEMENT is made between Riverside Special Utility District, a political subdivision created under the laws of the State of Texas (hereinafter called the District) and the applicant, (hereinafter called the Applicant or Customer).
The District shall sell and deliver water service to the Applicant and Applicant shall purchase, receive, and/or reserve water service from the District in accordance with the Order Setting Rates and Policies of the District as amended from time to time by the Board of Directors of the District.
The Customer shall pay the District for service hereunder as determined by the District’s Order Setting Rates and upon the terms and conditions set forth therein, a copy of which has been provided as information packet, for which the Customer acknowledges receipt hereof by execution of this Agreement.
All water shall be metered by meters to be furnished and installed by the District. The meter is for the sole use of the Customer and is to provide service to one (1) dwelling and/or only one (1) business. Extension of pipe or pipes to transfer utility service from one property to another to share, resell, or sub-meter water to any other persons, dwellings, business, and/or property, etc., is prohibited.
The District shall have the right to locate a water service meter and the pipe necessary to connect the meter on the Customer’s property at a point to be chosen by the District, and shall have access to its property and equipment located on Customer’s premises at all reasonable times for any purpose connected with or in the furtherance of its business operations, and upon discontinuance of service the District shall have the right to remove any of its equipment from the Customer’s property.
The District’s authorized employees shall have access to the Customer’s property, premises, and facilities at all reasonable times for the purpose of inspection, to insure compliance with state required Minimum Acceptable Operating Practices for Public Drinking Water Systems as promulgated by the Texas Commission on Environmental Quality or successor agency, applicable plumbing codes, and utility construction standards.
The District strictly prohibits the connection of service pipelines from its water service meter to any private well or other unknown water supply.
In the event the total water supply is insufficient to meet all of the needs of the Customers, or in the event there is a shortage of water, the District may initiate the Emergency Rationing Program as specified in the District’s Water Conservation Plan. With execution by the Applicant of this Agreement, Applicant hereby shall comply with the terms of said Plan.
The customer shall install at his own expense any necessary service lines from the District’s facilities and equipment to the point of use, including any customer service isolation valves or other equipment as may been specified by the District. The use of pipes and pipe fittings that contain more than .25% lead or solders and flux that contain more than 0.2% lead is prohibited for any plumbing installation or repair of any residential or nonresidential facility providing water for human consumption and connected to the District.
By execution hereof, the Customer shall hold the District harmless from any and all claims for damages caused by service interruptions due to waterline breaks by utility or like contractors, tampering by other customers of the District, normal failures of the system, or other events beyond the District’s control.
The Customer shall grant to the District, now or in the future, any easements of right-of-way for the purpose of installing, maintaining, and operating such pipelines, meters, valves, and any others such equipment which may be deemed necessary by the District to extend or improve service for existing or future customers, on such forms as required by the District.
By execution of this Service Application and Agreement, applicant agrees that non-compliance with the terms of this Agreement by said Applicant shall constitute denial or discontinuance of service until such time as the
violation is corrected to the satisfaction of the District.
Any misrepresentation of the facts by the Applicant on any of the three pages of this form shall result in discontinuance of service pursuant to the terms and conditions of the District’s Policies.
I agree.
Your Signature
(Required)
Use your finger or mouse to sign this agreement. Please note that electronic signatures are binding.
Date
(Required)
Month
Day
Year
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