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LCMUA Service Application & Agreement

Steps

1. Step One This section is complete This section is incomplete
2. Service Address Property This section is complete This section is incomplete

Step One

Date*
Date
Requested Start Date*
Requested Start Date
All dates for service need to be confirmed by customer service.
Primary Contact First Name*
Primary Contact Last Name*
Address*
City
State
Zip Code
Home Phone
Cell Phone
Best Contact Phone Number*
Email Address*
Date Of Birth*
Date Of Birth
If another responsible adult lives in household, please enter information next:
First Name*
Last Name*
Address*
City
State
Zip Code
Home Phone
Cell Phone
Best Contact Phone Number
Email Address
Text Messaging
You agree that Lake Cities Municipal Utility Authority and those acting on our behalf may send you text (SMS) messages at the phone number you provide us. These messages may include operational messages about your use of the Service. Text messages may be sent using an automatic telephone dialing system. Standard data and message rates may apply whenever you send or receive such messages, as specified by your carrier. If you wish to opt out of all text messages from Lake Cities Municipal Utility Authority, you can email utilitybilling@lcmua.org, however you acknowledge that opting out of receiving all messages may impact your use of the service. You may continue to receive text messages for a short period while we process your request, including a message confirming the receipt of your opt-out request. Your agreement to receive texts is not a condition of any purchase on or use of the Service.
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Service Address Property

Please answer the following questions about service address property.
Do You Own, Buying From Owner Or Rent Your Property*
Do You Have A Pool*
Do you have a sprinkler system*
Lake Cities Municipal Authority Waiver Statement
I agree to waive my right to be present at the above address, at the time Lake Cities Municipal Authority connects service to stated address. I do hereby indemnify & hold harmless the Lake Cities Municipal Authority, it's agents and employees, from and against all claims, damages, losses and expense, including but not limited to, attorney fees arising out of or resulting from any negligent performance of water connection services on the above stated property referenced herein.
Statement Waiver Answer*
RED FLAG RULES NOTICE (Effective November 1, 2008)
LCMUA has adopted an "identity theft prevention program" designed to detect, prevent, and mitigate identity theft in connection with the opening of a covered account or an existing covered account and to provide for continued administration of the program in compliance with part 681 of title 16 of the code of federal regulations implementing section 114 and 315 of the Fair and Accurate Credit Transactions Act (FACTA) of 2003.
For our customers-what does this mean to you? After you submit this form to us you must
Confirm your identity by providing your driver's license or state issued id, to our customer service department. This is required before service will be connected.

It also means that anytime you call to inquire about your account, for any reason, you will be required to provide one of the following forms of account identification:
1. Date of Birth
2. Last Four Digits of Social Security Number
3. Driver's License Number
4. Password on Account

If you prefer a personal password, please indicate your selection below.
Requested Password
CONFIDENTIALITY NOTICE
LCMUA is a government-operated utility; therefore, account information in considered public record under the Texas Public Information Act. Section 182 of the Texas Utilities Code allows residential customers to request personal information and information related to water usage, billing amounts, and payment records be kept confidential. Personal information includes, but is not necessarily limited to, mailing address, telephone number, and social security number.

Government-operated utilities are NOT prohibited from disclosing personal information in a customer's account to:
1. Government Officials
2. Consumer Reporting Agencies
3. Contractors or subcontractors who need the information to do their jobs
4. Utility Representatives
5. Individuals for whom the customer has waived confidentiality (must be in writing).
Individuals in these categories will be required to identify themselves before information will be released.

If you do not want this service, no response is necessary. Information cannot be kept confidential until this form is completed or a letter is received and processed by LCMUA.
I request all personal information, and any information relating to water usage, billing amounts, or payment records be kept confidential.
1. Request Confidentiality
By typing your name in this section, you are applying for utility service with Lake Cities Municipal Utility Authority. You understand that no services will be connected until you have either come by the office of electronically submitted all required documentation including all required identity information to our customer service department.
Service Agreement (TCEQ Regulatory Guidance Effective February 19, 2004)
Purpose: The Lake Cities Municpal Utility Authority, hereinafter referred to as LCMUA, is responsible for protecting the drinking water supply from the contamination or pollution, which could result from contamination or pollution, which could result from improper plumbing practices. The Purpose of this agreement is to notify each customer of the plumbing restrictions, which are in place to provide said protection.

The LCMUA enforces all of these regulations to ensure the public health and welfare. As a part of your Utility Application, you are required to sign this Service Agreement, before LCMUA will begin any services. In addition, when service has been suspended or terminated, the LCMUA will NOT re-establish service until a copy of this agreement is on file.

* Plumbing Restrictions: The following undesirable plumbing practices are prohibited by state regulations

A. 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 backflow prevention device.

B. 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 in the service connection by the installation of an air-gap or a reduced pressure-zone backflow prevention device.

C. No connection, which allows water to be returned to the public drinking water supply, is permitted.

D. 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.

E. No solder or flux, which contains more than 0.2% lead, may be used for the installation or repair of plumbing at any connection which provides water for human use.

*Service Agreement: the following are the terms of the service agreement between LCMUA and:
Name Of Account Holder*
Service Address*
City
State
Zip Code
Service Agreement Terms
A. LCMUA will maintaine a copy of this agreement as long as the Customer and/or the stated address utilities are connected to our system.

B. The customer shall allow his property to be inspected for possible cross-connections and other undesirable plumbing practices. These Inspections shall be conducted by LCMUA or it's designated agent prior to initiating service and periodically thereafter. The Inspections shall be conducted druing LCMUA'S normal business hours.

C. LCMUA shall notify the customer in writing of any cross-connection or other undesirable plumbing practice which has been identified during the Initial Inspection or the Periodic Follow Up Inspection.

D. The Customer shall, at their expense, properly install, test, and maintain a backflow prevention device required by LCMUA. Copies of all maintenance records shall be provided to LCMUA.

E. The Owner must be aware that installation of a residential dual check valve results in a potential closed plumbing system within his residence. As such, provisions may have to be made by the owner to provide for thermal expansion within his closed loop system, i.e., the installation of thermal expansion devices and/or pressure relief valves.

Enforcement: if the customer fails to comply with the terms of the service agreement, LCUMA shall at it's option, either terminate service or properly install, test, and maintain an appropriate backflow prevention device at the service connection. Any expense associated with the enforcement of this agreement shall be billed to the customer.
Please Type Your Name Here to Acknowledge Confirmation of Above Information-You Will Be Required to Sign This Form When Confirming Account Information and Identity*

Leave This Blank:

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

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LCMUA Service Application & Agreement

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