New User Registration / Account Activation

Anonymous User Registration

Creating this type of account will allow you to submit anonymous service requests. You should create your account with this form if you wish to submit service requests but do not have any accounts with the City of Bethlehem (e.g. a utility bill). If you wish to conduct city business (e.g. pay bills online) you should instead visit this page to activate your account. You will also be able to submit service requests through that account.

Name *
Mailing Address Line 1 *
Mailing Address Line 2
Mailing Address Line 3
Mailing City/State *
Mailing Zip *
Primary Phone *	(123-456-7890)	Ext

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

* = Required field