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Application for Service

2. City of Decatur
   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.
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