Service Request Form 2020 - Brushy Creek MUD

Please use the form below to connect or disconnect Water Utility Service. Once you click the submit button below your request will be sent to the District's Customer Service Department and a Customer Service Representative will respond within one business day.

Last Name_First Name

Main Phone

*Note: Phone number must be in XXX-XXX-XXXX format.

Phone

Home
Work
Cell

Driver License Number or Passport or Business EIN

Driver License State

Your Email Address

Property Type

Residential
Commercial

Service Request Information * Please note: Transfer is to be used if you currently have service with BCMUD and are moving to another property within our service area.

New
Final
Transfer (moving from one house to another within BCMUD)

Service Request DateDate you would like the service done (Monday - Friday)

Service Address

City

Round Rock, TX
Austin, TX

Zip Code

Billing or Forwarding Address

Same as above
See billing address below
Forwarding Address - See billing address below

Billing Street City State ZipPlease include STREET address, CITY, STATE, ZIP CODE

Standard is 1 solid waste cart and 1 recycle bin ($24.03)

Additional carts

Additional Solid Waste Cart ($7.04)
Additional Recycle Cart ($7.04)

Paperless BillingWould you like to be paperless and have your bills emailed to you?

Yes, Go Paperless
No, please mail me a bill

1st Authorized Account Individual Name

1st Authorized Account Individual Phone Number

2nd Authorized Account Individual Name

2nd Authorized Account Individual Phone Number

Previous resident of the Brushy Creek MUDHave you previously been a resident of the Brushy Creek MUD?

Yes
No

Property

Rent
Own
I own the property, but I am renting it out

If renting, please provide landlord's name and phone number.

Name of landlordfirst and last

*Note: Phone number must be in XXX-XXX-XXXX format.

Phone Number of landlord

Would you like the landlord listed on the accountWe cannot discuss account details with anyone that is not on the account.

Yes
No

PRIVACY ACT: The District is obligated under the Texas Open Records Act to give out personal and private information on customers (Such as name, address, telephone number, social security, etc.). Under the act, this information is accessible to salesman, bill collectors, disgruntled spouses, telephone solicitors, junk mail listing or anyone else that may want to know about you and your account.If you DO NOT want any information given out regarding you or your account, please initial below.

Initials Agreeing to Privacy ActI (we) request that under the Privacy Act, the District not release any information: Initials:

New Service Fees:

Standard 5/8" meter Deposit ($100)+ Admin Fee ($30) - $130

3/4” Meter Deposit ($150) + $30 Admin Fee ($30) - $180

Transfer Fee $30

Surcharges (Surcharges are stackable. E.G. if a customer sets up same-day service on a Saturday, a weekend fee of $60 would be added to the same-day service fee of $90 for a total of $150):

Same-day service surcharge - $90

Weekends or holidays between 8 a.m.-5 p.m. surcharge - $60

Afterhours 5 p.m.-8 a.m. surcharge - $60

Signature

Date Signed

PLEASE NOTE: Request made will be processed twenty four (24) hours after contact by BCMUD and payment (Deposit / Admin Fee) is made. Service request can only be made Monday - Friday except for Holidays and extenuating circumstances.

Notes

I have read utility bill charges and fees

Click the link at the bottom of this form to read utility bill charges and fees.

*** Click SUBMIT at the bottom (scroll past "Staff Use Only")

- - - For Staff Use Only - - -

Received By and Date Received

Receipt Number

Account Number

Meter Size

Work Order

Water Service Request Form

New Service Fees:

Surcharges (Surcharges are stackable. E.G. if a customer sets up same-day service on a Saturday, a weekend fee of $60 would be added to the same-day service fee of $90 for a total of $150):

*** Click SUBMIT at the bottom (scroll past "Staff Use Only")