NO: Online .
SO: _________
City of Stephenville * 298 West Washington * Stephenville, TX 76401
Phone Number (254) 918-1220 * Fax Number (254) 918-1207
APPLICATION FOR UTILITY
Residential Account Name Change Only 72 Hour Account
Date to Open Account: _____________________________________ Account Number: ______________________________
Name: __________________________________________________________________________________ Gender
Social Security#: _________________________ Driver’s License or ID: _______________________________ State: _______
Date of Birth: _______________ Home Phone: ___________________________ Work Phone: __________________________
Employer’s Name: _______________________________________________________________________________________
Co-Applicant: ___________________________________________________________________________ Gender
Social Security#: __________________________ Driver’s License or ID: ______________________________ State: _______
Date of Birth: ________________ Home Phone: ____________________________ Work Phone: _________________________
Employer’s Name: ______________________________________________________________________________________
Do you rent ( ) or own ( ) Landlord’s Name: _____________________________________ Phone: _____________________
Service Address: ___________________________________________________________________________________________
Mailing Address: ____________________________________________________________________________________________
Water Deposit Amount: $150.00 Connection Fee: $ 20.00 Amount Paid: ___________________
Payment Method: Cash Credit Card Card Type:
Check Check #_____________ Bank _____________________________________________________________________
Commercial Date to Open Account: _____________________________
Name of Company or Business: ________________________________________________________________________________
Legal Representative: _____________________________________________________________________________________
Drivers License: ___________________________________ Social Security#: ______________________________________
Federal Tax Id#: ____________________________________ Phone Number: ________________________________________
Service Address: ____________________________________________________________________________________________
Mailing Address: ____________________________________________________________________________________________
Water Deposit Amount: ____________________ Connection Fee: $ 20.00 Amount Paid: ___________________
Payment Method: Cash Credit Card Card Type:
Check Check #_______________ Bank ___________________________________________________________________
A SERVICE DEPOSIT SHALL BE REQUIRED WHICH SHALL BE EQUAL TO AN ESTIMATE OF THE COST OF SIXTY (60) DAYS
UTILITY SERVICE, WITH A ONE HUNDRED FIFTY DOLLAR ($150.00) MINIMUM DEPOSIT FOR RESIDENTIAL SERVICE OR A
FIVE HUNDRED DOLLAR ($500.00) MINIMUM DEPOSIT FOR COMMERCIAL SERVICE. THE AMOUNT OF THE DEPOSIT
SHALL BE ESTIMATED BY THE UTILITY BILLING CLERKS OR HIS OR HER AUTHORIZED REPRESENTATIVE WHERE
BILLING FIGURES FOR A COMPARABLE ESTABLISHMENT IS NOT AVAILABLE.
_________________________________________________ _____________________________________________________
Applicant Signature Date Co-Applicant Signature Date
_________________________________________
Water Department Approval Date
Do you wish your personal information to be confidential? Yes No
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