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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
         
 
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