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2. Please check the City of Longview Privacy Policy and Disclaimer before completing this form.
4. Section 4 - Commercial Business Account Information
6. Business Name*
7. Tax Identification Number
   Please be prepared to supply the Tax Identification Number.
9. Service Address*
10. Service Date Requested
12. Mailing or Billing Address (if different than above)
14. Primary Telephone Number*
15. Email
17. Requesting Commercial Garbage and Recycling Services
    Your once per week commercial garbage service includes one regular trash cart and one recycle cart. For extra carts, please indicate quantity.
19. How many extra garbage carts are needed?
    -- Select One --0123

    $7.50 each, per month, plus tax
20. How many extra recycling carts are needed?
    -- Select One --0123

    $5 each, per month, plus tax
24. Please read the City of Longview Retail Water Service Agreement before completing this form.*

    1. I have read the Retail Water Service Agreement
    2. I have read the Ready Access to Utility Service Equipment
    3. I have read the Personally Identifying Information for Account Purposes
26. PLEASE READ CAREFULLY:
    By submitting this application, I agree to the above statements and acknowledge that all information I have provided is true and correct. By signing this application electronically or manually, I certify that I have read and understand all of the information regarding this Application for Water Utility Service, which includes the Retail Water Service Agreement, and agree to these terms and conditions.
28. Statement of Agreement*
    By typing your name in the above box, you agree to the terms of the City of Longview Retail Water Service Agreement
29. Date
Leave This Blank:


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

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field