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*** $35.00 Non-Refundable Fee
for seven (7) working days ***
STOP! Please complete this form if you do not already have service.
Account # __________________ TX DL or ID # ___________________
Connect Date ______________________
AM/PM Receipt# ____________________ Received By ________________________
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.
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.
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
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