Today's Date *

MM

DD

YYYY

Start Date of New Service *

MM

DD

YYYY

Name on Account *

First Name

Last Name

Secondary Name on Account (optional)

Co-account holder or "in care of"

First Name

Last Name

New Service Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone Number *

(###)

###

####

Secondary Phone Number

If different than Cell Phone OR Secondary account holder

(###)

###

####

Resident Type *

Owner

Renter

Property Management

Customer Status *

I am a new customer

I am a current or previous customer

Reminder: City of Bend sewer system

If your property is within Bend city limits, your sewer service is provided by the City of Bend—unless you have a septic system. For questions, you can reach them at 541-388-5515.