Residential Account Request Form
401 N 3rd St. 254-298-5616
Temple, TX 76501 firstname.lastname@example.org
Service Start Date - (Weekdays Only)
Preferred Service Connection Time:
Service Street Address
Do you own or rent this property?
Is the Mailing Address the same as the Service Address?
Mailing Address (If different than Svc Address)
Mailing Address City
Mailing Address State
Mailing Address Zip Code
Alt Phone Number
Drivers License #
Social Security #
Date of Birth
Would you like to receive an e-bill?
Please select Yes or No
Yes, I would like to receive an E-bill
No, I do not want to receive an E-bill
Please Select One
E-mail and Paper Statement
I understand that I need to provide a valid picture ID to establish service. A photo can be uploaded below, a copy can be emailed to email@example.com or it can be faxed to 254-298-5263.
Upload Driver's license or picture ID
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.