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2. Start Date:*
   Start Date:
3. Deposits

   Deposit inside city limits: $125

   Deposit outside city limits $150

   Staff will notify you via email of your deposit amount.

   Deposits are to be paid in person or over the phone ($1 service fee will be assessed).

5. Name*
6. Phone Number*
8. Service Address*
10. Mailing Address*
12. City*
13. State*
14. Zip Code*
16. Email Address*
18. How would you like your bill?*
    -- Select One --PrintEmail
20. I hereby agree to the following conditions (Please Initial):

23. 1. Turn on hours are Monday - Friday, from 8 am to 5 pm, a resident is not required to be present at the home for turn on.

26. 2. I agree to notify the Schertz Utility Billing Office, at least one business day notice, before ending service.
29. 3. I understand the deposit will be applied to my bill after 2 years of good payment history, or applied to my final bill if service is less than two years.
32. 4. I further agree that if I do not receive my bill, it is my responsibility to contact the Schertz Utility Billing office for the amount due. Failure to receive a bill does not entitle payment without penalty.
35. 5. Any alteration to the meter from its original state, as installed by city personnel, will constitute forfeiture of deposit and may result in theft of service charges.
38. 6. I understand and acknowledge if a sprinkler system is present on my property, it is my responsibility to adjust and maintain the settings to avoid high consumption which may result in a large bill.
41. 7. I agree to keep the Schertz Utility Billing Office informed of any changes in contact information, the Schertz. Utility Billing Office will not be responsible for any problem that may arise by not being able to contact the account holder.
44. (OPTIONAL) I hereby request the account records at the Schertz Utility Billing Office be kept confidential, as permitted by the Texas Open Records Act, defined by House Bill 859 (effective 9-1-93).
46. Account Holder Information:
48. Name*
50. Phone Number*
51. Alt. Phone Number
53. Employer
54. Employer Phone Number
56. Secondary Account Holder Information:
58. Name
60. Phone Number
61. Alt. Phone Number
63. Employer
64. Employer Phone Number
66. Secondary Account Holder authorized to make decisions/changes and may have financial obligations to account balances:*

    1. Yes
    2. No
    3. N/A
68. Emergency Contact*
69. Phone Number*
71. Upload Lease Agreement or Closing Disclosure*
    Submit a copy of your Lease Agreement or Closing Disclosure.
73. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
75. Electronic Signature*
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field