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Application for Service
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City of Decatur
Application for New Service/Residential
Service Request Date:
*
Service Request Date:
Service Type
*
Residential
Commercial
Do You
*
Rent
Own
Service Address
*
City
*
State
*
Zip
*
Mailing Address (if different from Service Address)
*
If mailing address is the same, please enter "n/a"
Primary Applicant Information
Applicant Name/Business Name
*
Email Address
*
If you do not have an email address, please enter "n/a"
Tax ID (commercial only)
*
If not a commercial account, please enter "n/a"
Home Phone #
*
Work Phone #
Cell Phone #
*
Bill Pay Options
Paper
Email (must provide an email address above)
Bank Draft Authorization (Bank Draft Authorization Form must be completed)
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.
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.
I UNDERSTAND THAT...
*
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
I UNDERSTAND THAT...
*
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
CONFIDENTIALITY REQUEST
I hereby request confidentiality of my personal information by the City of Decatur’s Utility Billing Division.
**All Delinquent Accounts will be sent to McCreary, Veselka, Bragg & Allen, P. C. Attorneys at Law
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.
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.
*
I AGREE
Signature: First M. Last
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