Page title

SERVICE START DATE

Service Start Date

CUSTOMER INFORMATION

First Name

Last Name

Phone Number

SERVICE ADDRESS

Service Address

Service Address 2

Number of Household Occupants

Utility Account #

MAILING ADDRESS

Mailing Address

City, State, Zip

PREVIOUS ADDRESS

Previous Address

Previous Address City, State, Zip

EMPLOYER INFORMATION

Employer

Employer Address

Employer City, State, Zip

Employer Phone Number

SPOUSE OR ROOMMATE INFORMATION

Spouse or Roommate First Name

Spouse or Roommate Last Name

Spouse or Roommate Employer

Spouse or Roommate Employer Address

Spouse or Roommate City, State, Zip

Spouse or Roommate Employer Phone Number

EMERGENCY CONTACT INFORMATION

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

PAYMENT INFORMATION

Billing City

Billing Country

Billing Zipcode

ORDER OPTIONS & SUMMARY

Deposit *

For New Customers Only: $53.00

*If not selected for New customer setup – Service application may be delayed until payment is received

Service Activation

Service Activation Add-On: $32.00

*If not selected for New customer setup – Service application may be delayed until payment is received

Same Day Service

Same Day Service Fee Add-On: $32.00

After Hours Service

After Hours Service Fee Add-On: $64.00

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Secure Payments with SSL Encryption

* Municipal Code 10.08.030 Service deposit: Every person on making application for municipal services shall make a service deposit to establish creditworthiness. A minimum deposit, not to exceed an amount equal to one year’s charges for municipal services, shall be established by resolution. The city manager or designee shall adopt policies covering requirements for and waivers of security deposits for municipal services. (Ord. 1691 § 1, 2004)

Once you submit your application, you will need to fax a copy of your Driver’s license to (650) 876-0256 or email a copy to webfinance@sanbruno.ca.gov

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Declaration: I agree to accept responsibility for service at the above requested location. I understand that payments are due 21 days following each billing cycle and failure to make payments on time will result in remedies authorized by City's Municipal Code including, but not limited to, delinquent penalties, service interruption and/or termination. I understand the water meter is property of the City of San Bruno and tampering with the meter is subject to fines, penalties and criminal prosecution. I agree to abide by these and all other regulations approved by the City Council and I verify that the above information is true and correct to the best of my knowledge.

I Agree

SUBMIT