New User Registration / Account Activation

Anonymous User Registration

Use this form to create an account if ... 1) You are a first time user AND 2) You are NOT currently a City of Bethlehem Utility Billing Customer, Real Estate Owner, Alarm Account Owner, or have a Misc. Bill to pay. NOTE: Once this account is created you will only be able to enter a Service Request.

Name (Last First MI) *
Mailing Address Line 1 *
Mailing Address Line 2
Mailing Address Line 3
Mailing City/State *
Mailing Zip *
Primary Phone *	(10 digits; no special characters)	Ext

Email *
Verify Email *
User Name *
Password *	(6-character minimum; no spaces)
Verify Password *
Secret Question *
Secret Answer *
Marital Status

* = Required field