Commercial Water-Sewer Service Application And Automatic Draft Forms - The Woodlands Joint Powers Agency


For Office Use Only
Today’s Date______________________
__________ - __________________ - __________
WO No.
Account Number
2455 Lake Robbins Dr.
The Woodlands, TX 77380
Phone: (281)-367-1271 Fax: 281-298-7216
Website address:
Application Fee: $35.00 (Non-Refundable)
Name of Applicant(s) (please print) _____________________________________________________Contact :___________________________
Service Address_____________________________________________________________________________________ZIP_______________
Main phone #__________________________Cell #____________________________E-Mail________________________________________
Bill to be sent to [ ] Service Address [ ] Email Address or [ ] Other Address:
[ ] 1” – 2” DEPOSIT
[ ] 3” – 4” DEPOSIT
Payment for Fees/Deposit will be made by: (Please mark one)
[ ] 6” – 8” DEPOSIT
[ ] Cash
[ ] Check
[ ] Money Order
Make check or M/O payable to:
[ ] 10” +
[ ] Master Card /Visa/Am Ex/Discover#_________________________________________
**All deposits are applied to final bills
Exp date: ________/_________ CVC Code:________________
when applicant disconnects service.
Mailing Address on Credit Card Statement _______________________________________
(If different than Service Address)
Applicant requests water and sewer services at the above service address and assumes full responsibility for payment of all charges based
on the District's established rates and for continuing compliance with the District's rules, regulations and policies until discontinuance of
such services and payment in full of the final bill.
Applicant understands and acknowledges that the District is a governmental agency and public utility engaged in the governmental
function of providing public water, sewer and drainage services, and that, by receiving and acting upon this application and by providing
or undertaking to provide such services, the District is not undertaking to conclude or enter into a contractual arrangement with Applicant,
to establish an open account with Applicant, or to undertake any continuing obligation to Applicant, other than to provide or undertake to
provide such governmental services to the premises in accordance with and subject to Applicant's continuing compliance with the
District's rules, regulations and policies. Accordingly, Applicant understands and acknowledges that by providing such services or by
administering rules, regulations and policies relating to acceptable plumbing practices and procedures, the District assumes no liability or
responsibility for resulting damages or injury, of any kind, to persons or property, including, without limitation, damages or injury
resulting directly or indirectly from the use of such services on the above premises or from any interruption, non-availability or
inadequacy of such services. Applicant further understands and acknowledges that it is Applicant's sole responsibility: (1) for any failure,
defects or inadequacies in the piping, plumbing, fixtures or appliances on the above premises and for any losses of water, damages, or
injuries resulting from same, (2) to maintain in serviceable condition all sewer lines within the property boundaries of such premises, and
(3) to furnish and maintain a private water service cut-off valve on the Applicant's side of the District's water meter(s) serving the
Finally, Applicant understands and acknowledges that: (1) water and sewer service bills will be calculated in accordance with the
District's established rate schedules, with water service based on the meter reading of the amount consumed for the period and sewer
service based on a calculated return flow of metered water consumption; (2) bills are due and payable upon presentation and payment may
be made at the office of the District; (3) a fee will be assessed to your account for all late notices; (4) any reconnect fees, additional
deposits, and all past due charges must be paid before any reconnection can be made on accounts disconnected for non-payment; (5)
separate water meters and billings, without accompanying sewer charges, are available from the District for irrigation purposes upon
Applicant's request, payment of applicable tap fees and water use charges, compliance with the District's rules, regulations and policies,
and assumption of responsibility for properly connecting Applicant's irrigation system to such irrigation water meter .
Date Service is to Begin ___________________________Applicant's Signature _________________________________________________
**A Drop Box is available in the parking lot at 2455 Lake Robbins Drive, The Woodlands, TX**
Website address:
**** To send this form, call for an email at 281-367-1271 or fax to 281-298-7216.****
Rev. 09/2015


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