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2. 
3. RESIDENTIAL APPLICATION FOR WATER AND SEWER SERVICE
   City of Nassau Bay, Texas
5. The following items are required one business day in advance:
   • Completed Residential Application for Water and Sewer Service
   • Copy of Driver’s License (for each applicant)
   • Copy of Voided Check (if selected for auto-draft)
6. Please submit paperwork to one of the following:
   • Email: city.receptionist@nassaubay.com
   • Fax #: 281-333-2301 (Attn: Water Department)
   • In person / drop box at City Hall (1800 Space Park Drive, Suite 200)
     
8. Names of Applicant(s)
9. Date to Establish New Account
   Date to Establish New Account
11. Service Address
13. Mailing Address (if different)
14. City / State
15. Zipcode
17. Home Phone
18. Cell Phone
19. Work Phone:
21. Email Address(es)
23. How would you like to receive your water bill each month (Select Only One Option):

    1. Mail Only

    1. Email Only
25. Employer
26. Applicant Status

    1. Buying

    1. Renting / Leasing
28. Driver's License # (DL COPY is required for EACH applicant):
29. State of Driver's License(s)
31. BANK DRAFT

    Please check the box if you would like your account set to auto-draft through your checking account. All drafts take place on/around the 17th of each month. A $25.00 charge is assessed for all returned transactions. If selected, you must include a voided check with your completed application.

    1. Yes, sign me up for auto-draft.
33. AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS TO THE CITY
    ACH Authorization Agreement (Bank Draft Form)

    Please complete this form to allow us to set your water account to auto-draft for each billing cycle and submit to the City in one of the following ways:

    • Email: city.receptionist@nassaubay.com
    • Fax: 281-333-2301
    • In person, by mail, via drop box at City Hall (1800 Space Park Drive, Suite 200)
    • Or upload using the upload link below
35. Upload ACH Authorization Agreement
37. OPTIONAL DONATION

    Please check if you would like to donate $2.00 each billing cycle to the Fire/EMS fund as part of your auto-draft transaction.

    1. Yes, I would like to make a $2.00 donation each month.
39. CONFIDENTIALITY

    Please check the box if you would like your account to be listed as confidential per Texas House Bill 859 of 1992 and the Public Information Act and be released only to the persons allowed by law.

    1. Yes, please keep my account listed as confidential.
41. NASSAU BAY ALERTS

    This Emergency Alert system allows City Officials to quickly send alerts via phone, email, or text message directly to residents and businesses. These alerts help keep you informed and safe in the event of emergency situations, including severe weather, road construction, water issues, etc. If you would like to be added to the call list, please CHECK the best way(s) to contact you based on the info provided above:

    1. Business Phone
    2. Cell Phone

    1. Other Phone
    2. Email

    1. Text
43. RESPONSIBLE PARTY:
    I request water and sewer service at the above premises and agree to use and pay in accordance with the City's established rates and rules. I further agree to be responsible for all the charges for water and sewer service for the above premises until I request discontinuance of such service and pay the final bill.
45. DEPOSIT HOME BUYER:
    A deposit of $100.00 is required to establish a new water account with the City. The deposit will be charged to the first month's bill. Copy of valid driver's license or ID for each applicant.
47. DEPOSIT RENTER OR LESSEE:
    A deposit of $200.00 is required to establish a new water account for renters or leasing tenants with the City. The deposit is due upfront in order to establish water service. Copy of a valid driver's license or ID is required for each applicant.
49. BILLING:
    All water accounts are billed on a monthly basis and payments are due in our office by the 17th of each month. Water payments received by mail are effective the day it is received in our office, not the postmark date.
51. There are several ways you can pay your water bill:
    1) Mail Payment
    2) Pay In-Person/Drop Box at City Hall
    3) ACH Bank Draft or Credit Card Draft
    4) Pay Online at www.nassaubay.com/waterbill
    5) Phone via Our Secure Provider Paymentus at (844) 234-9886 ($400 or less)
52. Please visit www.nassaubay.com for info on:
    Residential Recycling
    Residential Trash Collection
    Utility Billing Policies & Procedures
    How to Access Your Water Account Online
    Utility Billing Water & Sewer Rate Schedule
54. Applicant's Signature(s)
    Please type your name acknowledging the above information you have provided is correct.
55. Date
    Date
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field