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2. 
3. Utility Billing Department

   Residential 2nd Rollout Request

5. Name*
6. Today's Date*
8. Service Address*
10. Account Number*
11. Phone #*
13. Driver's License #*
14. Government issued PHOTO ID*
16. Additional Requests
18. Service Rollout Form
    Click here for signature on second rollout
20. Service Agreement Contract
    Click here to view the Service Agreement Contract
22. Please remember to call our Utility Billing Office at 325-646-9700 for payment of deposit for completion of application. Thank you!
24. Applicant Signature:*

    By typing your name you agree that you have read and agree to the terms and conditions of the Service Agreement Contract in the link provided above.

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field