Apply for water service

Blue Topaz Utilities
P.O. Box 2927
Conroe, TX 77305-2927
936-756-7400
info@bluetopazutilities.com

*Please call office prior to completing forms to receive your acct#

Name on Account (required)

Account Number (required)

Mailing Address (required)

City (required)

State (required)

Zip Code (required)

Home Phone

Cell Phone (required)

Start Date of Service (required)

Email (required)

Property Address (required)

City (required)

State (required)

Zip Code (required)

If renting or leasing please list property owner

I have read and understand the Rules and Regulations understand and agree that such service is subject to the Rules and Regulations of Blue Topaz Utilities. I, the undersigned, will be responsible for any and all charges for service as required by said Rules and Regulations .

Date (required)

Please write your signature in the box below (required)

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