SERVICE ADDRESS:
ACCOUNT NAME:
EMAIL:
MAILING ADDRESS:
DRIVERS LICENSE:
PRIMARY PHONE: Cell Work Home
SECONDARY PHONE: Cell Work Home
IMPORTANT: An account holder may request their personal information be kept confidential. If an account holder
makes such a request of confidentiality, the City of Montgomery shall keep their personal information confidential
unless required or mandated by law.
Yes, request confidentiality No, do not request confidentiality
NEW RESIDENTIAL TAP APPLICATION
City of Montgomery
101 Old Plantersville Rd, Montgomery Texas 77316
(936)-597-6434 www.montgomerytexas.gov
I understand that I am responsible for my City of Montgomery Utility bill each month until the City of
Montgomery has received a completed disconnect application for my account.
I understand that failure to receive a bill does not remove the responsibility to pay the amount due by the due
date.
Applicant Signature:
Date Completed: Print Name:
WATER TAP: $1,115.00
DEPOSIT: $125.00
APPLICATION FEE: $30.00
SEWER TAP: $2,600.00
SEWER INSPECTION FEE: $50.00
CSI FEE: $100.00
TOTAL: $4,020.00
Employee Signature: Processed Date:
Account Number:
click to sign
signature
click to edit
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