Form Center

Step One

Note: Due to the passing of House Bill 872, all customer account information is confidential
City of Baytown
Residential Application
Service Request*
1. New Service
1. Transfer Service
1. Disconnect
1. Change of Mailing Address
Are you a first time resident to Baytown?*
1. Yes
1. No
SERVICE ADDRESS
Address*
Apartment/Suite
Apartment/Suite/Other
City*
State*
Zip Code*
MAILING ADDRESS
Address
Apartment/Suite
Apartment/Suite/Other
City
State
Zip Code
TRANSFER SERVICE ADDRESS
ADDRESS
Apartment/Suite
Apartment/Suite/Other
City
State
Zip Code
Social Security Number and Driver's License
Your social security number and driver's license are needed to complete the application. Please call the office with that information. (281) 420-6515.
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First Name
Last Name
Phone Number
Owner/Renter
1. Property Owner
1. Renter
Landlord Name
Landlord Phone Number
Authorization
1. I authorize the City of Baytown to disclose information regarding my usage, services, and billing, including amounts billed or collected for utility usage.
Understanding
I understand the City will provide water service by turning on a meter that services this property. The City will not enter the property to determine if there are any open faucets or water system leaks, as it is my responsibility to ensure the property is service ready. I agree to release and hold harmless the City from all claims that arise out of or in connection with the City’s providing water service to this property, including damages caused by open faucets or water system leaks. The City will not be required to leave the water on if the meter indicates an open line.
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Old Customer
Customer Number
Work Order Number
Work Order Number
Contract Number
Deposit Posted
Deposit Amount
Received
1. Check
2. Cash
3. Credit
Today's Date
Today's Date
Schedule Date
Schedule Date
Comments
Note
Should customer have an outstanding balance prior to establishing the new account, the previous balance owed will automatically be transferred to the new account and may be subject to disconnect if not paid with the current bill. Additionally, all sprinkler meters with usage must have a deposit on the account. If usage is detected, the required deposit and service charge will automatically be billed to the account and may be subject to disconnect if not paid with the current bill.
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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.
Electronic Signature*
1. I agree
Electronic Signature*
Date*
Date

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