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2. City of Decatur
   Application for New Service/Residential
4. Service Request Date:*
   Service Request Date:
5. Service Type*

   1. Residential
   2. Commercial
6. Do You*

   1. Rent

   1. Own
8. Service Address*
9. City*
10. State*
11. Zip*
13. Mailing Address (if different from Service Address)*
    If mailing address is the same, please enter "n/a"
15. Primary Applicant Information
17. Applicant Name/Business Name*
18. Email Address*
    If you do not have an email address, please enter "n/a"
19. Tax ID (commercial only)*
    If not a commercial account, please enter "n/a"
21. Home Phone #*
22. Work Phone #
23. Cell Phone #*
25. Secondary Applicant Information

    If there is no Secondary Applicant, please enter "N/A"

27. Applicant Name*
28. Email Address*
30. Home Phone #*
31. Work Phone #*
32. Cell Phone #*
34. Voluntary Donation*

    I would like to make a voluntary donation of $1 per month to Decatur Parks/Main Street Fund

    1. Yes
    2. No
36. Bill Pay Options

    1. Paper
    2. Email (must provide an email address above)

    1. Bank Draft Authorization (Bank Draft Authorization Form must be completed)
38. Copy of Lease Agreement/Proof of Ownership*
    A copy of your lease agreement or proof of ownership is REQUIRED and may be uploaded here, emailed to utilities@decaturtx.org, or submitted in person. We must receive a copy of your lease agreement or proof of ownership BEFORE deposit is paid and service is started.
39. Copy of Valid Driver's License/State ID*
    A copy of your valid driver's license or state ID is REQUIRED and may be uploaded here, emailed to utilities@decaturtx.org, or submitted in person. We must receive a copy of your valid driver's license or state ID BEFORE deposit is paid and service is started.
43. I UNDERSTAND THAT...*

    Rental Aggrements and/or Closing Documents, Valid Driver's License, and the Utility Deposit are required to start service. I am responsible for the utility bill until the City of Decatur receives a completed and signed Service Disconnection document.

    1. I Understand
44. I UNDERSTAND THAT...

    Utility Bills are due by the 15th of each month, subject to a 10% penalty the next business day and interruptpon of service 10 days after the due date. Additional fees may apply. If service is interrupted, it will not be restored until all past due amounts and fees are paid in full. 

    
    

    1. I Understand
45. I UNDERSTAND THAT...*

    The City reserves the right to inspect the property for possible cross connections and other undesirable plumbing practices.  Texas State Plumbing Regulations apply to all properties. 

    1. I Understand
49. Signature
    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.
51. I agree to the above statement and confirm that all the information on this application is true and accurate to the best of my knowledge.*

    1. I AGREE
53. Signature: First M. Last
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

* indicates a required field