Application for Water & Wastewater Utility Service

If you have any questions about this application, please call our office at 1-877-718-4396.
If you prefer to print and mail in your application, you can download a PDF version.

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Required fields are marked with an asterisk and highlighted.

Applicant Information Note: At least one phone number (either home, work or cell) is required.
Name:*
Mailing Address:*
City, State & Zip:*
Home Phone:	(ex. 512-555-1234)
Work Phone:	(ex. 512-555-1234)
Cell Phone:	(ex. 512-555-1234)
Last 4 digits of SS#:*
Email Address:

Name of additional person authorized to make changes to this account:

Address of Requested Service Note: Some regions require a supplemental grinder pump agreement.
Service Address:*
City, State & Zip:*
County:*
Subdivision:*
Region:*
Block:
Lot:
Acreage:
Single-family residence?*
Approx. square footage:*
Number of toilets:*

Have you previously had service with LCRA?*

Requested Services*
Note: At least one service must be checked.

	water at an existing location
	wastewater at an existing location
	wastewater at an existing location with grinder pump
	water at a new location
	wastewater at a new location
	wastewater at a new location with grinder pump
	temporary service - fire hydrant meter
	extension of service to unserved area

Additional Information
Applicant Is:*
Customer Type:*
Is this a new connection?*
Meter Size:*
Please enter size:*	(value should be in inches)
Is this a landlord account?*
Approx. date service is needed:*
	Note: Service date must be at least 2 business days in future, must not fall on a weekend and must not be more than 180 days in the future.

Special Service Needs

	pool
	fire sprinkler
	irrigation
	other

Under the Texas Utilities Code, Section 182.01 through 182.005, persons 60 or older with a utility account will not receive a 10% penalty until the bill is past due by 25 days.

Are you or any person authorized on this account 60 or older?* (age verification will be required if over 60)

Section 182.052 of the Texas Utilities Code requires government-operated utilities to notify customers of their right to confidentiality. You are hereby informed that you have the right to request confidentiality of your address, telephone number, social security number and information relating to the volume or units of utility usage and the amounts billed to or collected from you for utility usage, as contained in our records. If a customer makes such a request of confidentiality, LCRA shall notify you of the request and keep the information described above confidential unless required or mandated by law.

Please be aware that if you requested confidentiality in the past, you also have the right to cancel that request for confidentiality. To exercise this right to cancel, please complete the information requested on this form and select NO below.

Do you request confidentiality of the information listed above?*

I acknowledge by submitting this agreement that upon accepting service I will be subject to the terms and conditions of retail water and/or wastewater service as contained in the Rate Schedule, as updated from time to time at the discretion of the LCRA Board of Directors. I further acknowledge and agree that the terms and conditions of retail water and/or wastewater service contained in the Rate Schedule shall constitute a contract between LCRA and me and may be enforced as such.

Do you agree to the terms and conditions outlined in the Rate Schedule?*

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