This form may be used by residential or commercial customers to begin, stop or transfer utility services. It may be submitted online with the personal identifying information to be completed by phone at 361-758-5301 or in person at City Hall.

Mark the one which applies for this application.*

Residential

Commercial

Mark the button which applies to this application *

Begin Service

Stop Service

Date To Turn On/Off Service:*

Applicant Name:*

Service Address:*

Utility Account Number

Check the box which applies.*

Property Owner

Rental Property

If rental property, complete the following:

Landlord's Name

Landlord's Phone Number

Applicant's Mailing Address:*

City, State, Zip*

Phone Number:*

Email Address:*

* **Additional Address for Service Transfer and/or Forwarding

Address

City, State, Zip

THE FOLLOWING PERSONAL IDENTIFICATION INFORMATION MUST BE COMPLETED IN PERSON OR BY PHONE. TO PROTECT THIS INFORMATION, DO NOT COMPLETE ONLINE.

Social Security Number

Driver License Number

THE FOLLOWING INFORMATION WILL BE COMPLETED BY UTILITY CLERK FOLLOWING COMPLETION OF APPLICATION.

Meter Number

MXU Number

Deposit Date or Deposit Return Date

Deposit or Refund Amount