CHANGES TO WATER UTILITY SERVICE ACCOUNT
Please complete all applicable sections. PLEASE PRINT
2000 Forest Ridge Dr., Bldg B 817-952-2112 customerservice@bedfordtx.gov
ACCOUNT INFORMATION
Water Account Number: ____________________________ Request Date: _______________________
Customer Name: __________________________________________________________________________
Current Service Address: ____________________________________________________________________
New Mailing Address: _________________________________ City/State: _______________________ Zip: _______
[If applicable]
CONTACT INFORMATION
Cell Phone: ______________________________________________________________________________________
Home Phone [If applicable]: _________________________________________________________________________
E-mail Address: __________________________________________________________________________________
Driver’s License: ____________________________________________ State: ________________ Exp: __________
CHANGE NAME ON ACCOUNT
Marriage: *Divorce: *Death of Spouse:
New Name: _____________________________________________________________________________________
*Please provide copy of divorce decree or death certificate. You may scan the document and email it to:
customerservice@bedfordtx.gov
or bring the copy to 2000 Forest Ridge Drive, Bldg B, 8:00am 5:00pm M-F.
REQUESTING SENIOR RATE FOR RESIDENTS AGED 65 or OLDER
Please either scan your current driver’s license and email the copy to: customerservice@bedfordtx.gov
or
come in person to 2000 Forest Ridge Drive, Bldg B, 8:00am 5:00pm M-F.
TRANSFER (WITHIN BEDFORD ONLY) OR DISCONNECT UTILITY ACCOUNT
Final-Out Date: __________ Forwarding Address: ____________________________________________________
_____________________________________________________________________
City State Zip
Transfer FROM Bedford Address: _______________________________________________ Date: _____________
Transfer TO Bedford Address: __________________________________________________ Date: _____________
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