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Residential Request for Service
Service Start Date
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Preferred Service Connection Time:
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Morning
Afternoon
Customer Name
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Service Street Address
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Do you own or rent this property?
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Own
Rent
Is the Mailing Address the same as the Service Address?
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Yes
No
Mailing Address (If different than Svc Address)
Mailing Address City
Mailing Address State
Mailing Address Zip Code
Phone Number
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Alt Phone Number
Drivers License #
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Social Security #
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Date of Birth
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Click here to read Privacy Policy
Acknowledgement
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I understand that I need to provide a valid picture ID to establish service. A photo can be uploaded below or a copy can be emailed to utilities@templetx.gov.
Upload Driver's License or Government Issued Photo ID
Acknowledgement
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Disconnection of service for non-payment does not close a utility account. The account may continue to bill until the account holder contacts the Utility Business Office to terminate the account. Customers will be held responsible for charges to the utility account as long as it is active in the customer’s name. Please contact the Utility Business Office to close your account when service is no longer needed.
By entering my full name and clicking ‘Submit’ below, I am providing my electronic signature and verifying that the information I have provided on this form is true and correct, and I am authorized to initiate new water service for the address listed on this application.
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Date signed
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