Home Departments Utility Billing Services Turn on or Disconnect Services Utility Service Request Form - Connect Service
Customer Information::Full Name: (First, Middle, Last)Current AddressCurrent Mailing Address (if different from service address)Current City:Current StateCurrent Zip Code:Phone:Email:Social Security #Driver's License Number
Where do you want service?New Service Address (Street Number and Address)Apt:Property Ownership:
Service Date Requested (What date do you want to turn on service)
Contact Person & Phone NumberAdditional Comments:Attachments: (Please attach lease agreement or any other require documentation)I hereby certify that the above information given is true and correct.
400 N Washington Beeville, TX 78102Ph: (361) 362-7600 or (361) 358-4641FAX: (361)358-7355