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Application for Service

2. City of Decatur
   <center></center> Application for New Service/Residential

   Application for New Service/Residential

4. Service Request Date:*
   Service Request Date:

5. Service Type*

   1. Residential
   2. Commercial

6. Do You*

   1. Rent

   1. Own

8. Service Address*

9. City*

10. State*

11. Zip*

13. Mailing Address (if different from Service Address)*

    If mailing address is the same, please enter "n/a"

15. Primary Applicant Information

17. Applicant Name/Business Name*

18. Email Address*

    If you do not have an email address, please enter "n/a"

19. Tax ID (commercial only)*

    If not a commercial account, please enter "n/a"

21. Home Phone #*

22. Work Phone #

23. Cell Phone #*

25. Bill Pay Options

    1. Paper
    2. Email (must provide an email address above)

    1. Bank Draft Authorization (Bank Draft Authorization Form must be completed)

27. Copy of Lease Agreement/Proof of Ownership*

    A copy of your lease agreement or proof of ownership is REQUIRED and may be uploaded here, emailed to utilities@decaturtx.org, or submitted in person. We must receive a copy of your lease agreement or proof of ownership BEFORE deposit is paid and service is started.

28. Copy of Valid Driver's License/State ID*

    A copy of your valid driver's license or state ID is REQUIRED and may be uploaded here, emailed to utilities@decaturtx.org, or submitted in person. We must receive a copy of your valid driver's license or state ID BEFORE deposit is paid and service is started.

32. I UNDERSTAND THAT...*

    1. The required deposit must be paid in full prior to start of service. If I move from this address, I will provide the City of Decatur a written notice stating the date of disconnection, the forwarding

33. I UNDERSTAND THAT...*

    1. The City reserves the right to inspect the property for possible cross connections and other undesirable plumbing practices. Texas State Plumbing Regulations apply to all properties. Service to an e

34. CONFIDENTIALITY REQUEST

    1. I hereby request confidentiality of my personal information by the City of Decatur’s Utility Billing Division.

36. **All Delinquent Accounts will be sent to McCreary, Veselka, Bragg & Allen, P. C. Attorneys at Law

40. Signature
    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.

    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.

42. I agree to the above statement and confirm that all the information on this application is true and accurate to the best of my knowledge.*

    1. I AGREE

44. Signature: First M. Last

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field