City of Braham Water/Sewer Application
201 S. Broadway, P.O. Box 521, Braham, MN 55006
Email:cityhall@braham.com
Phone: 320-396-3383   Fax:320-396-3478    TDD: 800-627-3529

                                                             
IS PRIMARY HEAT SOURCE WATER? YES_____ NO______

 Date:__________________                  Account#_________________

Billing Name:__________________________________________

Billing Address:________________________________________

Actual Location (If different from above)_______________________________________

Phone#-Home_______________________ Phone# Work__________________________

All accounts must be in the name of the property owner and/or renter. (Circle one) PROPERTY OWNER'S NAME __________________

The home owner/occupant is responsible to include a current water meter reading along with the water/sewer bill payment due on the 14th of each month. $10.00 estimate fee and/or $20.00 reading fee will be applied each month if reading is not provided.

Late payments are assessed at a charge of $10 or 10%; whichever is HIGHER.

All payments are to be made payable to: City of Braham by the 14th of each month.

New service fee (nonrefundable) $25.00 will be included on first billing

Also available for purchase, 2nd meters for summer irrigation-ask for details at City Hall

INITIAL/MOVE-IN METER READING (READINGS SHOULD HAVE 7 DIGITS PLEASE USE ALL NUMBERS ZEROS INCLUDED)______________

I HAVE READ AND UNDERSTAND THE ABOVE STIPULATIONS

  Signature _______________________________        Date ______________________________

Please provide the following information so that the City Of Braham will be in compliance with Title VI of the Civil Rights Act of 1964. The information regarding race, color, or national origin designation is requested in order to assure the Federal Government, that the City Of Braham complies with Federal Laws prohibiting discrimination on the basis of race, color, or national origin. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your request for services or to discriminate against you in any way. However, if you choose not to furnish this information, we are required to note your race and national origin on the basis of visual observation or surname.

Please check the appropriate information below:

RACIAL CATEGORIES

___ American Indian or Alaskan Native ___ Asian

___ Black or African American ___ Native Hawaiian or Pacific Islander ___ White

ETHNIC CATEGORIES    ___ Hispanic or Latino ___ Not Hispanic or Latino