City Of Pasadena, Texas
Residential Services Application
Please note that applications will not be processed without the following:
• Photo identification, SSN and a deposit (Owner - $125, Renter - $150).
• First and last pages of either the settlement statement or lease agreement
• All names on ownership or lease documents will be listed on the account. Please note that the account will be billed
as of the date on the aforementioned documents and may be subject to back bill charges.
• Additional deposits are required if there is a separate meter for irrigation (sprinkler) purposes (based on size of meter).
If there is a swimming pool at the service address, an additional $25 deposit is also required.
• NOTE: We reserve the right to hold or delay service requests if service location was recently disconnected for non-
payment.
Connect Date: _________________________ Service Address: _____________________________________________________________________
Applicant Name: ________________________________________________________ Driver’s License or ID#_____________________________
Date of Birth: _________________ Is applicant 65 or Older? Yes No If yes, applicant qualifies for discounted rates.
SSN: ______________________________ Contact#: ______________________________ Alternate Contact#: ___________________________
Email Address: ______________________________________________________________
Mailing Address (if different from Service Address): ________________________________________________________________________________
Spouse/Other Occupant Name: __________________________________________ DL or ID#______________________ DOB: ___________________
Spouse/Other Occupant SSN: _____________________________________________ Contact#: _____________________________
Owner Name (if renting): ____________________________________________________ Owner Phone# ________________________________
Account Confidentiality Request: Section 182.052 of the Texas Utilities Code provides that a government-operated utility such as the City of
Pasadena may not disclose personal information in a customer’s utility account or other information related to utility usage or billing if the
customer requests that the information be kept confidential. The Texas Utilities Code also allows the utility to access a fee for this request.
Please choose one of the following:
_____ Yes, I request confidentiality. I understand there is a $2 one-time fee. _____ No, I do not request confidentiality.
I (we) hereby apply for services at the above address. I (we) understand that there is a $30.00 non-refundable connect fee
to cover maintenance and administrative costs related to opening an account. I (we) understand that the bill is due and
payable 18 days from the billing date. Failure to receive a bill does not waive penalty nor does it extend the due date. In
addition, I (we) am aware that I (we) don't need to be home to connect service, but if there is a leak, open pipe or open
faucet (dial on meter is moving), the technician will turn the water off at the meter. If I (we) request for City staff to return to
the premises to turn the water on, there will be a $20.00 return trip fee.
In addition, I/we understand that the City of Pasadena verifies the personal information provided on this application using
various databases. If the City determines that I or other people shown as owners or listed on a lease owe past due
balances to the City, I/we will be responsible for payment of those balances or can be transferred to this account.
Signature: __________________________________________________________ Date: _______________________________________
Co-Occupant Signature: ____________________________________________ Date: _______________________________________
IMPORTANT - Please note that your water and sewer bills are based on the amount of water you use. Every customer has a
water meter that separates the city's water system from his/her private plumbing system. Once the water passes through the
meter, the customer has purchased it and it no longer belongs to the city.
Notice: Per City Ordinance #2008-107, the City charges a water and sewer meter size base fee for all meters larger than the
standard 5/8th.
1202 Southmore Ave 77502 · PO Box 1337 · Pasadena, TX 77501-1337 · Phone (713) 475-5566 · wbcs@pasadenatx.gov
For Office Use Only:
CSR Initials/#: _______________ Same Day Connect? Y N Account#: ___________________________________
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
