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Step One

Commercial - New Service Application for Water and Wastewater
Service Start Date*
Service Start Date
Customer Information
First Name
Last Name
Phone Number
Email Address
Service Address
Address
Address 2
Number of Household Occupants*
Utility Account #
(If new account, please leave blank)
Mailing Address
Address
City
State
Zip Code
Previous Address
Address
City
State
Zip Code
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Step Two

Employer Information
Employer
Phone Number
Address
City
State
Zip Code
Spouse or Roommate Information
First Name
Last Name
Address
City
State
Zip Code
Phone Number
Email Address
Spouse or Roommate Employer Information
Employer
Phone Number
Address
City
State
Zip Code
Emergency Contact Information
First Name
Last Name
Phone Number
Email Address
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Step Three

Payment Information
* 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)
Additional Deposit amount may be required depending on business type. Please call us at (650) 616-7086 to verify if an additional amount will be required. Otherwise Service may be delayed until payment of deposit is complete.
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
Electronic Signature Agreement*
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.
1. I agree.
Electronic Signature

Leave This Blank:

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

This field is not part of the form submission.
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