2. FIRE HYDRANT METER APPLICATION

4. READ ALL INSTRUCTIONS AND QUESTIONS PRIOR TO SUBMISSION

   Please fill out the form below in order to submit a request for a fire hydrant meter.  

   In order for the form to be considered complete, please note that the applying entity must download, sign, and upload a copy of the Fire Hydrant Meter Agreement and Water Service Agreement. Links to these documents are provided in the form below.   

   Additionally, a deposit in the amount of $3,000.00 must be paid prior to the release of the meter. This deposit can be made online or via a check. Please make all checks payable to the Town of Northlake. Checks can be submitted in person or mailed to the Town of Northlake at:   

   Northlake Utility Billing Department
   1500 Commons Circle STE. 300
   Northlake, TX 76226 

   Once the check for the deposit has been received, a receipt will be issued within 3-5 business days of receiving the check. This receipt should then be shown to the Town of Northlake Public Works department who will then issue a meter to the qualifying entity.  

   Please contact the Northlake Utility Billing Department with any questions regarding this form, payment, or fire hydrant meters.

8. Application Type*

   Type of Application:

   1. New Fire Hydrant Meter

   1. Update Billing Information

   1. Other (explain below)
10. If Other, please provide any additional information or instructions:
12. Service Type

    Please note that a water meter deposit fee and meter set fee will be required based on meter size.

14. Commercial Type*

    1. Owner Occupant/Builder

    1. Landlord/Property Manager

    1. Renter/Tenant
16. Water Service Information
18. Requested Service Start Date*
    Requested Service Start Date

    Please note that businesses/builders requesting a fire hydrant meter will need to pick the meter up from Public Works. Prior to Public Works releasing the meter, businesses/builders must show the receipt that demonstrates that they have paid all required fees and deposits for the meter.

20. Service Address/Location*
22. City*
23. State*
24. Zip Code*
26. Billing Contact Information
28. Name of Business or Customer*
30. Title of Billing Contact
31. Name of Billing Contact*
33. Address*
35. Main Office Phone Number
36. Billing Contact Phone Number*
38. Billing Contact E-mail Address*
40. City*
41. State*
42. Zip Code*
44. Driver's License Number or Tax Identification Number (TIN):*
45. State*
47. Account Privacy*

    With your authorization, the Town of Northlake can withhold the release of your personal information (i.e. phone number, social security number, and address) pursuant to Section 182.052 of the Texas Utilities Code. Do you want your personal information associated with your water service account kept confidential?

    1. Yes, keep my personal information confidential

    1. No, the Town is allowed to release my personal information
49. Billing Options*

    Utility bills can be sent via e-mail or postal service. Bills sent via e-mail will be sent to the e-mail address provided in the Billing Contact Information section of this application. Please choose how your bill is received:

    1. Yes, send my bill via e-mail
    2. No, I do not want my bill sent via e-mail
51. Required Forms & Documents*

    Download the documents in this section and indicate that you have downloaded and reviewed the required forms and documents. The Water Service Agreement must be signed and re-uploaded in the Account Authorization and Approval Section.

    1. Yes, I have downloaded and reviewed the required documents and forms
53. Fire Hydrant Meter Agreement
    Click to view and download form
55. Water Service Agreement
    Click to view and download form
57. Public Notice Requirement for Notification Upon Usage of Chloramines
    Click to view and download notice
59. Important Changes to Fire Hydrant Meter Accounts
    Click to view and download document
61. Account Authorization and Approval*

    I am an authorized representative of my organization and by signing below, I understand that I am responsible for this account and that all bills must be paid on or before the due date or be subject to late charges and/or possible termination of service. I agree that the printing of my name, in conjunction with signing and submitting the Fire Hydrant Meter Agreement and Water Service Agreement, constitutes a binding signature and authorization for this account.

    1. Yes, I am an authorized representative and I agree with the above statement on behalf of my organization
    2. No, I do not agree with the above statement
63. Title of Representative*
64. Name of Representative*
66. Date of Approval*
    Date of Approval
68. Fire Hydrant Meter Agreement*

    Upload the signed agreement here.

    
    

69. Water Service Agreement*

    Upload the signed agreement here.

71. Notice of Required Fees & Receipts*

    I understand that a refundable deposits in the amount of $3,000 required prior to the meter being released by the Public Works Department. Payment can be made online or by a check that is submitted in person or through the mail. (Please address any mail to the Utility Billing Department and state the purpose of the check).

    I understand that should equipment be damaged, that this deposit will be forfeit and the deposit will be used to help cover the cost of replacing the equipment. 

    I also understand that a receipt will be provided within 3-5 business days via e-mail from the date that the Town of Northlake receives payment, and that this receipt must be shown to Public Works prior to Public Works releasing the meter. 

    1. Yes, I understand that a deposit in the amount of $3,000 is required prior to the release of the meter and that the reciept must be shown to Public Works

75. Please click Submit or Submit and Print after completing the form. Please make sure that all required sections of the form have been completed. Upon completion of the form, you will be returned to the main page for the Town of Northlake's website.

Leave This Blank:


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

    This field is not part of the form submission.

79. Submit Submit and Print

* indicates a required field