501 James St. Tomball, TX 77375
Phone: 281-290-1401 or 281-290-1424
Fax: 281-351-4735
Utilitybills@tomballtx.gov
Revised: Jan. 6, 2020 Official Use only: Deposit Amount ____________ Completed _____________
City of Tomball
Residential Utility Service Application
Your account will be confidential unless otherwise noted.
____ (Please initial) I do not want my account information to remain confidential.
Date to Start Service: ________________ Account No: ___________________
Will be issued by City of Tomball
Service Address: _______________________________________________________________
Buying _____ Renting _____ Would you like a Recycle Bin? Y___ N___
*Note: Takes 2-3 weeks for delivery*
Applicant Information:
Name of Applicant: _____________________________________________________________
Co-Applicant:__________________________________________________________________
Mailing Address: ___________________________________________ Apt./Suite No. _______
*if different from service address*
City: _____________________________ State: ________________ Zip: ______________
Cell Phone: ________________________ Home Phone: ______________________________
Work Phone: _______________________ Employer: _________________________________
E-Mail Address: ________________________________________________________________
Paperless options: Email only ________ Email & Paper copy _________
Identification:
Applicant DL #: ____________________ State: _______ Social Security #: _______________
Applicant Date of Birth: __________________________
Co-Applicant DL#: __________________ State: _______ Social Security #: _______________
Co- Applicant Date of Birth: _______________________
__________________________ _____________________
Signature Date
click to sign
signature
click to edit
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