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.
5. TODAY'S DATE*
   TODAY'S DATE
6. SERVICE ADDRESS*

   Haslet does NOT provide water and trash services to areas outside Haslet city limits. Please verify that your address is in Haslet city limits by going to www.tad.org and putting your address in the property search field. Northstar, Sendera Ranch, Dorado Ranch, Emerald Park, Spring Ranch, Haslet Heights, and surrounding subdivisions are NOT in Haslet city limits.

7. Service Start Date*
   Service Start Date
   Service start date must be Monday-Friday. Service cannot start on a weekend or holiday. If it is after 1:00 pm, then your service will start on the next business day.
9. Applicant or Company Name*
11. Applicant Driver's License No. & State*
12. Applicant Social Security Number*
14. Email Address for Primary Contact*
16. Mailing Address if Different from Service Address
18. City
19. State
20. Zip Code
22. Home Phone Number*
23. Cell Phone Number*
24. Work Phone Number*
26. Employer Name*
28. Employer Address if Different from Service Address*
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 made in order to establish the account and remains on the account for the life the account. At the time of the account's final bill, any remaining deposit is refunded. Once your account has been established, you will receive an email containing an online link to make your deposit payment. Otherwise your deposit payment may be made by mail, in person at City Hall or via phone with credit card (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. Pay your bill, manage your account and set up automatic payments online at Haslet.org. The account # and PIN will be in the top right corner of your statement.

    Weekly trash & recycling collection is every Wednesday. Please have your carts by the street/curb by 7am.

    Monthly bulk trash collection is scheduled for the 1st Wednesday every month. Items should be placed by the street/curb by 7am.

Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

* indicates a required field