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Rosenberg Animal Control & Shelter Water Bill Donation Form

  1. RACS Utility Bill Donation Form

    Rosenberg residents can now make monetary donations to the Rosenberg Animal Control and Shelter (RACS) on their monthly water utility bill. The donated funds will be used to promote positive outcomes for shelter animals including caring for extenuating medical conditions, behavioral training programs and enrichment programs.

  2. Donor Information

    Form must be completed by the utility account applicant or co-applicant.

  3. Donation Description

    The option requested below by the account holder will automatically be added to your utility bill until the account holder chooses to discontinue the monthly donation by completing a request to remove the donation from the utility account.

  4. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  5. RACS ROUND UP DONATION

    Choosing this option will round up your utility bill to the next whole dollar amount with the change ($0.01 to $0.99) and will be automatically charged each month.

  6. RACS FIXED AMOUNT DONATION

    Choosing this option will add a set dollar amount (any amount) to your utility bill which will be automatically charged each month.

  7. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  9. This field is not part of the form submission.