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2. 
4. Residential Water Service Application
   Request for new service and deposit received after 3:00 PM will result in connection on the following business day.
5. Date:
7. I am interested in signing up for the ACH Monthly Bank Account Draft:

   A completed Automatic Debit Authorization Form is required

   1. Yes
   2. No
8. I want to receive my statement by:

   1. E-Mail
   2. Mail
   3. E-Mail and Mail
10. Service Address:
11. Start Date:
    *Cannot be on a weekend or holiday.*
13. Primary Applicant Name:

    Only the Primary Applicant will be able to make changes to or disconnect account. 

14. Co-Applicant:
16. Driver's License Number:*
17. Social Security Number:*
18. Co-Applicant Driver's License Number:
19. Co-Applicant Social Security Number:
21. E-Mail Address:
22. Co-Applicant E-Mail Address:
24. Billing Address (if different from service address):
25. City and State:
26. Zip:
28. Home Phone Number:
29. Cell Phone Number:
31. Is this a rental property?

    1. Yes, Please Provide Information Below
    2. No
33. Property Owner's Name:
34. Property Owner's Phone Number:
38. Trash Can and Recycle Containers

    *Refuse service is $20.63 per month for one (1) trash cart and one (1) 95 gallon recycle cart. If you require an additional trash container there is a monthly charge that will be added to your bill each month in the amount of $10.67. If you require an additional recycle cart there will be a monthly charge that will be added to your bill each month in the amount of $2.13. Trash & Recycle carts must be out no later than 7:00 AM on your service day. Please note any bins/carts not out at 7:00 AM and are missed will not be picked up that week.

40. Number of Trash Cans Needed:

    If you require an additional trash container there is a monthly charge that will be added to your bill each month in the amount of $10.67.

41. Number of 96-Gallon Recycle Carts Needed:
    Each additional 96-gallon carts is $2.17 additional per month.

45. A copy of the account holder's US government-issued ID (such as a driver's license) and proof of residency (lease or closing papers) must be provided to establish service. You may submit this information via email, fax, mail, in the drop box or in person at 1900 C D Boren Pkwy.

47. I hereby apply for water services at the above address, to be furnished at the standard rates and under the terms and conditions of the City of Fate, on file in the City Office. The $50.00 application fee is non-refundable, water ($100) and/or sewer ($50) deposit is due at the time of application. The deposit may be submitted by mail, in office or in the drop box.
49. I acknowledge water service will be turned on at the above property. I will not hold the City of Fate responsible for any property damage to the water being turned on without my presence. I acknowledge if the meter shows water usage, it will be turned back off and my presence will be required for connection of service.
51. Notice of Customer’s Right to Request Disclosure

    Pursuant to section 182.052 of the Texas Utilities Code and section 552.1331 of the Texas Government Code, with certain exceptions the City of Fate may not disclose personal information in a customer’s utility account record, or any information relating to the volume or units of utility usage or the amounts billed to or collected from the individual for utility usage, unless the customer requests that the City disclose the information. To request disclosure of any such information, you must complete a Utility Disclosure Form and return it by email to utilities@cityoffate.com or by mail to City of Fate, 1900 CD Boren parkway, Fate, Texas 75087. You may rescind any such request by providing written notice to the City.

55. Service Agreement
57. Purpose.
    THE CITY OF FATE is responsible for protecting the drinking water supply from contamination or pollution, which could result from improper plumbing practices. The purpose of this service agreement is to notify each customer of the plumbing restrictions, which are in place to provide this protection. The utility enforces these restrictions to ensure the public health and welfare. Each customer must sign this agreement before the CITY OF FATE will begin service. In addition, when service to an existing connection has been suspended or terminated, the water system will not re-establish service until it has a signed copy of this agreement.
59. I. Plumbing.
    The following unacceptable plumbing practices are prohibited by State regulations.
61. 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 back-flow prevention device.
63. 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 back-flow prevention device.
65. A. No connection, which allows water to be returned to the public drinking water supply, is permitted.
67. B. No pipe or pipe fitting which contains more than 8.0% lead may be used for the installation or repair of plumbing at any connection, which provides water for human use.
69. C. No solder of flux, which contains more than 0.2% lead, can be used for the installation or repair of plumbing at any connection, which provides water for human use.
71. II. Service Agreement.
    The following are the terms of the service agreement between the CITY OF FATE (the Water System) and the Customer. The Water System will retain a copy of this agreement as long as the Customer is active.
73. The Customer shall allow his property to be inspected for possible cross-connections and other unacceptable plumbing practices. 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 unacceptable plumbing practices exist; or after any major changes to the private plumbing facilities. The inspections shall be conducted during the Water System's normal business hours.
75. A. The Water System shall notify the Customer in writing of any cross-connection or other unacceptable plumbing practice, which has been identified during the initial inspection or the periodic re-inspection.
77. B. The Customer shall immediately correct any unacceptable plumbing practice on his premises.
79. C. The Customer shall, at his expense, properly install, test, and maintain any back-flow prevention device required by the Water System. Copies of all testing and maintenance records shall be provided to the Water System.
81. D. The Customer acknowledges that bills are mailed monthly and should they not receive one they should contact Utility Billing for the bill amount. If the bill is not paid on time, a late payment fee will be assessed to the account. Service will be disconnected with an additional re-connection fee charged and the bill and all fees must be paid prior to the re-connection of service.
83. E. To disconnect service customers will complete Disconnect Form and will make request in person or via email.
85. III. Enforcement.
87. If the Customer fails to comply with the terms of the Service Agreement, the Water System shall, at its option, terminate service or properly install, test, and maintain an appropriate back-flow prevention device at the service connection. Any expenses associated with the enforcement of this agreement shall be billed to the Customer.
89. Disconnection Notice
    Utility statements are due on the 15th of every month, penalties are added on the 16th of every month and payments must be made by 8am on the 25th of every month to avoid disconnection. If your account is disconnected for nonpayment, a $50 reconnection fee will be applied. Additionally, disconnected accounts are subject to deposit requirements pursuant to City Council Ordinance O-1197. The total amount past due plus reconnection fees and deposits must be paid in full before water will be reconnected.
91. Customer's Signature:
92. Date:
94. Internal Use Only
96. Start Date: ____________
97. Today's Date: _____________
98. Account Number: ___________________
100. Amount Paid: ____________________
101. Received By: ____________________
105. Phone: 972-771-4601 Opt: 2

106. E-Mail: Utilities@FateTX.Gov

107. Fax: 972-722-8266
Leave This Blank:


109. 1. Receive an email copy of this form.
110. Email address

     This field is not part of the form submission.

111. Submit

* indicates a required field