Residential Utility Service Application

2. 

3. RESIDENTIAL UTILITY SERVICE APPLICATION
   Complete the following online application. Select Print and Submit. The application will be submitted to the Utility Billing Department for Processing.

   Complete the following online application. Select Print and Submit. The application will be submitted to the Utility Billing Department for Processing.

5. TODAY'S DATE*
   TODAY'S DATE

6. SERVICE ADDRESS*

7. Service Start Date*
   Service Start Date

   Service start date must be Monday-Friday. Service cannot start on a weekend or holiday.

9. Applicant or Company Name*

11. Applicant Driver's License No. & State*

12. Applicant Social Security Number*

14. Mailing Address if Different from Service Address

16. City

17. State

18. Zip Code

20. Home Phone Number*

21. Cell Phone Number*

22. Work Phone Number*

24. Employer Name*

26. Employer Address if Different from Service Address*

28. Email Address for Primary Contact*

30. Co-Applicant Name*

31. How would you like to receive your bills?*

    If nothing is checked you will receive your bill by regular mail.

    1. By Email
    2. By Regular Mail
    3. Both
33. Please check the one that applies*
    1. Owner
    2. Renter

    1. Builder/Contractor

    1. Realtor

    1. Other

35. Emergency Contact*

36. Phone Number*

38. Have you previously had utility service in the City of Haslet?*
    1. Yes
    2. No

39. In the event of a public inquiry, do you authorize the City to withhold your name and address?*
    1. Yes
    2. No

41. To request a trash cart(s) and/or recycling cart(s), please indicate below:
    -- Select One --Trash Cart-1 & Recycling Cart-1Trash Cart-1Recycling Cart-1Trash Cart-2 and Recycling Cart-1Trash Cart-2Recycling Cart-2Trash Cart-2 and Recycling Cart-2

    There is an additional charge per month for more than one trash cart at the residence.

43. Required Picture Identification

    Upload a copy of one of the following: Driver's License, State Issued I.D. Card, Military I.D. Card, Passport, Etc.

44. Required Deposit is $100
    Deposit must be paid at the time of application and remains on the account for the life the account. At the time of the account's final bill, any remaining deposit is refunded. Payment accepted is cash, check, money order, and credit cards (additional 2% fee applied when paying by credit card). Credit cards accepted are Visa, MasterCard and Discover.

    Deposit must be paid at the time of application and remains on the account for the life the account. At the time of the account's final bill, any remaining deposit is refunded. Payment accepted is cash, check, money order, and credit cards (additional 2% fee applied when paying by credit card). Credit cards accepted are Visa, MasterCard and Discover.

46. TERMS OF ACCEPTANCE AND SIGNATURE

49. I, the applicant for Residential Utility Service, warrant the truthfulness of the information provided in this application. *

    Please type your first and last name.

51. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above terms of acceptance.*
    1. Accept

53. New accounts will not be set up until a deposit has been made. At this time deposits cannot be made online; only over the phone, by mail, or in person at City Hall.

Leave This Blank:


56. 1. Receive email copy
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field