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Membership Application & Agreem BEAR CREEK SUD [email protected] Telephone 1-972-843-2101 P.O. Box 188 Lavon, Texas 75166 Requirements for New Service Paperwork Required: • Completed Service Application & Agreement online at https://bearcreeksud.com/all-forms-and- reports . • Copy of your signed Warranty Deed or Deed of Trust provided at closing. If Renting/Leasing then a copy of your lease or rental agreement is needed. Applicant name must be listed on the deed or lease. • Copy of Photo Identification – Driver License or Passport • Notarized Right of Way Easement may be required. After providing a copy of your deed, this will be provided for you to sign and have notarized if needed. Fees Required: • Owner deposit & account fee of $250.00 ($200 deposit /$50 account fee) Tenant deposit & account fee $300.00 ($250.00 deposit/$50.00 account fee) Deposits are refundable upon cancellation of service. Deposit & Fee must be paid within 3 business days of your start date Cash, Check, Money Order can be mailed to the P.O. Box 188 Lavon, TX 75166 or placed in the night drop box located on the front of the building. Credit Card payments can be submitted online through the website after you have been provided with an eight-digit account number. Payment Website: https://www.iwebms.net/bearcreeksud or Payment by phone at 972-843-1631. There is a convenience fee per transaction for this service the amount will be provided to you before you confirm your payment. • If you’ve purchased property that will need a meter installed, please contact the office for pricing. Important Information • No fencing is to be installed around the meter box unless a gate is located beside the box making it easily accessible to the meter reader. • All New Construction and Remodels will require a Customer Service Inspection. • Water Leaks on the customer’s side of the meter are the responsibility of the customer. Cost of repair and water used is the customer’s responsibility. Bear Creek SUD does not provide leak adjustments. • Backflow Prevention Inspections are required annually. Bear Creek SUD will notify you of the inspection date and registered testers by mail for you to arrange for the inspection. If you have an irrigation sprinkler system and onsite sewage facility (septic system) an RPZ will need to be installed. Page 1 BEAR CREEK SUD Telephone 1-972-843-2101 P.O. Box 188 Lavon, Texas 75166 CUSTOMER REQUEST THAT PERSONAL INFORMATION CONTAINED IN UTILITY RECORDS WITH BEAR CREEK SPECIAL UTILITY DISTRICT NOT BE RELEASED TO UNAUTHORIZED PERSONS Chapter 182, Subchapter B of the Texas Utilities Code provides utility customers with the right to request that their address, telephone number, and social security number be kept confidential. A customer also has the right to request that information relating to the volume or units of utility usage or the amounts billed to or collected from the customer for utility usage be kept confidential, unless the primary source of water for the utility is a sole-source designated aquifer. Your response is not necessary if you do not want this service. WE MUST STILL PROVIDE THIS INFORMATION UNDER LAW TO CERTAIN PERSONS. We must still provide this information to (1) an official or employee of the state or a political subdivision of the state, or the federal government acting in an official capacity; (2) an employee of a utility acting in connection with the employee’s duties; (3) a consumer reporting agency; (4) a contractor or subcontractor approved by and providing services to the utility or to the state, a political subdivision of the state, the federal government, or an agency of the state or federal government; (5) a person for whom the customer has contractually waived confidentiality for personal information; or (6) another entity that provides water, wastewater, sewer, gas, garbage, electricity, or drainage service for compensation. _____________________________ ______________________________ Name of Account Holder Account Number _____________________________ ______________________________ Address Area Code/Telephone Number _____________________________ ______________________________ City, State, Zip Code Email Address _____________________________ Signature BCCON102 Page 2 Bear Creek Special Utility District DISTRICT USE ONLY Date Approved ______________ Service Application and Agreement Service Classification ________ Cost ________________________ Please Print DATE ________________________________________ Work Order Number _________ Eng. Update _________________ APPLICANT’S NAME __________________________________________________________ Account Number ____________ Service Inspection Date ______ CO-APPLICANT’S NAME ______________________________________________________ CURRENT BILLING ADDRESS: FUTURE BILLING ADDRESS: ________________________________________ ________________________________________ ________________________________________ ________________________________________ E-Mail Address ______________________________________ Sprinkler System: YES/NO PHONE NUMBER - Home/Cell (_____)___________________ Work (______)________________________ PROOF OF OWNERSHIP PROVIDED BY _______________________________________________________ DRIVER’S LICENSE NUMBER OF APPLICANT _________________________________________________ LEGAL DESCRIPTION OF PROPERTY (include name of road, subdivision with lot and block number): ________________________________________________________________________________________________ PREVIOUS OWNER’S NAME AND ADDRESS ________________________________________________________________________________________________ ________________________________________________________________________________________________ HOUSEHOLD SIZE - SQ. FT.____________ Number of Adults in Household _____________ SPECIAL SERVICE NEEDS OF APPLICANT:____________________________________________________ ________________________________________________________________________________________________ NOTE: FORM MUST BE COMPLETED BY APPLICANT ONLY. A MAP OF SERVICE LOCATION REQUEST MUST BE ATTACHED. Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color, or national origin in programs and activities receiving Federal financial assistance. Recipients of Federal Financial Assistance are required to collect data necessary to document compliance with this law. The information regarding race, national origin, and gender designation solicited on this application is requested in order to assure the Federal Government, acting through USDA Rural Development, of compliance with Federal laws prohibiting discrimination against applicants on the basis of race, color, national origin, and gender. You are not required to furnish this information; however, you are encouraged to do so. The information will not be used in evaluating your application or to discriminate against you in any way. If you choose not to furnish this information, we are required to complete it based on visual observation or surname. ETHNIC IDENTIFICATION: Hispanic or Latino Not Hispanic or Latino ______________________________________________________________________________________________________ Race WHITE BLACK or AFRICAN AMERICAN ASIAN AMERICAN INDIAN/ALASKAN NATIVE MALE NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER FEMALE Page 3 IM# BCSA101 AGREEMENT made this __________ day of _______________________________, ________, between Bear Creek Special Utility District, a District organized under the laws of the State of Texas (hereinafter called the District) and _____________________________________________________, (hereinafter called the Applicant). The District shall sell and deliver water and/or wastewater service to the Applicant and the Applicant shall purchase, receive, and/or reserve service from the District in accordance with the bylaws and Rate Order of the District as amended from time to time by the Board of Directors of the District. Upon compliance with said policies, including payment of a Deposit Fee, the Applicant qualifies as a new customer and thereby may hereinafter be called a Customer. The Customer shall pay the District for service hereunder as determined by the District's Rate Order and upon the terms and conditions set forth therein, a copy of which has been provided as an information packet, for which Customer acknowledges receipt hereof by execution of this agreement. A copy of this agreement shall be executed before service may be provided to the Applicant. The Board of Directors shall have the authority to discontinue service of any Customer not complying with any policy or not paying any utility fees or charges as required by the District's published rates, fees, and conditions of service. At any time service is discontinued, terminated or suspended, the District shall not re-establish service unless it has a current, signed copy of this agreement. If this agreement is completed for the purpose of assigning utility service as a part of a rural domestic water and/or wastewater system loan project contemplated with the Farmers Home Administration, an Applicant shall pay an Indication of Interest Fee in lieu of a Deposit Fee for the purposes of determining a. The number of taps to be considered in the design and b. The number of potential ratepayers considered in determining the financial feasibility of constructing 1) a new water system or 2) expanding the facilities of an existing water system, the Applicant hereby agrees to obtain, utilize, and/or reserve service as soon as it is available. Applicant, upon qualification for service under
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