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Current Service Address

**CONNECTION AND DISCONNECTION MUST BE WITHIN 10 DAYS**
**Service ONLY Monday - Friday 8:00 am - 4:00 pm. 24 HR Notice Required. No Service on Holidays!**
Service Address to Disconnect*
City*
State*
Zip Code*
Account Number*
Disconnection Date*
Disconnection Date
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**Service ONLY Monday - Friday 8:00 a.m. - 4:00 p.m. 24 HR notice required. No Service on Holidays!**
New Address*
City*
State*
Zip Code*
Billing Preference*
Paper or electronic statements
1. Paper
2. Electronic
Connection Date*
Connection Date
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Applicant's Name*
Co-Applicant's Name
Date of Birth*
Date of Birth
Driver's License #*
Driver's License #
Last 4 # of Social or Tax ID*
Last 4 # of Social or Tax ID
Phone*
Phone
Email*
Email
Government ID*
Government ID
Senior Citizen*
Under the Texas Utilities Code, Section 182.001 through 182.005, persons 60 or older utility accounts’ will not receive a 10% penalty until the bill is past due by 25 days. Are you or any person authorized on this account 60 years or older?
1. Yes - (please provide verification of age)
2. No
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I understand if the above dates should change and extend over 10 days, a transfer request cannot be completed. A new Residential Application will need to be created with a $100.00 deposit billed on the first bill.*
I understand that there is a $25 Service Fee to be paid to complete the application process. Payment can me made over the phone with a Credit Card (Visa or MasterCard) at 512-401-5300.*
I understand that The City will not be responsible for damages to the property or inside the home due to any water leak or open lines upon or after the City restores service.*
I understand that any outstanding bill on the current account must be paid prior to transfer even if it is not yet past due. The final bill for the original account will be transferred to and be payable on the due date of the new account.*
Electronic Signature*
Co-Applicant Signature
Today's Date*
Today's Date

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