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Application for Temporary Water Services

  1. The City of Balch Springs Logo

  2. Application for Temporary Water Service

    *** $35.00 Non-Refundable Fee for seven (7) working days ***

  3. STOP! Please complete this form if you do not already have service.

  4. OFFICE USE ONLY

    Account # __________________ TX DL or ID # ___________________ ST___________________ DOB____________________ Connect Date ______________________ AM/PM Receipt# ____________________ Received By ________________________

  5. PLEASE READ CAREFULLY

    Customer or a Customers Representative MUST be on the premises at the service location when the service representative arrives. Additional service call(s) will require additional service charge(s) that will be billed to the applicant. Any water usage over 5,000 gallons will be billed in a separate statement. No solid waste service is provided with the temporary service.

  6. 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.

  7. Check Payment

    Make checks payable to City of Balch Springs. Please sign and return this completed form along with your check to City of Balch Springs, Attn: Utility Billing Dept., 13503 Alexander Road, Balch Springs, TX 75181

  8. Leave This Blank:

  9. This field is not part of the form submission.