Trash and Sewer New Services Form

Your Name

Your Email

Service Street Address

Account Holder Name

Account Holder Social Security Number

Account Holder Phone Number

Secondary Account Holder Name

Secondary Account Holder Social Security Number

Secondary Account Holder Phone Number

Email Address (for billing purposes, if selected)

Previous Address

Mailing Address

Street

City

State

Zip

Do you have now, or have had in the past, an account with the City of Sierra Vista?

Send my bill by:

You will be billed every other month. Please note that annual billing ("year in advance") is available after you establish your account. Annual billing is for July 1 through June 30 only. By paying for the year in advance, you can save 10% off your bill. If you would like to be billed annually, please submit an Account Change form after your service has been established.

Are you:

If you are a Tenant, please complete the section below.
Property manager name or company name

Property manager name or company phone number

Please select your service (check all that apply). Rates are for a two-month billing cycle.

Effective date of service:



Please note that there is a one-time $20.00 fee to establish new service, which will be included on your first bill.

By checking this box, I acknowledge that I will be billed all applicable fees as noted above. I further certify that I am the account holder of the above listed property. I understand that I am financially responsible for the services provided to me by the City of Sierra Vista. I agree to pay my account charges in a timely manner. If it becomes necessary, I agree to pay a 10% penalty fee for delinquent payments and reasonable fees associated with the collection of any past due account. This electronic form is as valid as the original.