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Residential Application Form

2. Start Date:*
   Start Date:
3. Deposit Date: *
   Deposit Date:
4. Deposit Amount: *
6. Name*
7. Phone Number*
9. Service Address*
11. Mailing Address*
13. City*
14. State*
15. Zip Code*
17. Email Address*
19. How would you like your bill?*
    -- Select One --PrintEmail
21. I hereby agree to the following conditions (Please Initial):
24. 1. Turn on hours are from 8 am to 5 pm, a resident is not required to be present at the home for turn on.
27. 2. I agree to notify the Schertz Utility Billing Office, at least one business day notice, before ending service.
30. 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.
33. 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.
36. 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.
39. 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.
42. 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.
45. (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).
47. Account Holder Information:
49. Name*
51. Phone Number*
52. Alt. Phone Number
53. Driver's License Number*
55. Employer
56. Employer Phone Number
58. Secondary Account Holder Information:
60. Name
62. Phone Number
63. Alt. Phone Number
64. Driver's License Number
66. Employer
67. Employer Phone Number
69. Secondary Account Holder authorized to make decisions/changes and may have financial obligations to account balances:*

    1. Yes
    2. No
    3. N/A
71. Emergency Contact*
72. Phone Number*
74. Upload Driver's License*
    Submit Copy of Driver’s License
75. Upload Lease Agreement or Closing Disclosure*
    Submit a copy of your Lease Agreement or Closing Disclosure.
77. 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.
79. Electronic Signature*
Leave This Blank:


80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit

* indicates a required field