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2. 
3. Utility Billing Department
   New Construction Builder Application
5. Service Address*
7. Connection Date*
   Connection Date
   Service Connection only Monday-Friday. 24 HR notice is required. No service on holidays.
9. Additional Requests
11. Contractor Name*
13. Customer Name*
15. Government issued PHOTO ID*

    Upload a copy of your ID.

17. Driver's License #*
18. Date of Birth*
    Date of Birth
20. Social Security #*
21. Phone #*
23. Email Address*
25. Mailing Address
27. Billing Preference*
    -- Select One --Paper BillE-Bill
29. A resident may request that their account information be kept confidential.*
    -- Select One --Yes - Request for ConfidentialityNo - Do NOT Request Confidentiality
31. I AGREE TO THE FOLLOWING:*

    Please check all boxes below to comply.

    1. I understand that I must pay the Utility Billing Deposit based on current Ordinance by contacting Utility Billing at (325)646-9700.
    2. I understand that government issued PHOTO IDENTIFICATION is required for connection. A scanned copy or picture is fine.
33. Service Agreement Contract
    Click here to view the Service Agreement Contract
35. Customer 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:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field