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 a two-week period 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

CONFIDENTIALITY OF PERSONAL INFORMATION. Under Section 182.052 of the Texas Utilities Code, an individual customer's address, telephone number and social security number, along with information relating to the volume or units of utility usage or the amounts billed for utility usage, are confidential unless a customer requests that a government-operated utility disclose the information. If you request that the District disclose such personal information, please mark the box below, initial it, and return this form to the District by mail or electronically at the following email address: customerservice@bcmud.org. A customer may also rescind a prior request for disclosure by marking the box below, initialing it, and returning this form by mail or electronically at the same email address. The following link may also be used by individual customers to request disclosure of personal information, or to rescind a prior request for disclosure of personal information:

I (we) authorize the District to disclose personal information.

Check to agree

Initial to agree

I (we) rescind a prior request that the District disclose personal information.

Check to rescind

Initial to rescind

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

Solid waste and recycling services from TDS will be delayed this week. Download the Waste Wizard app here.

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")