Form Center

2. 
4. To Whom It May Concern:
6. Print Name*
   I authorize The City of Balch Springs Minor Repair and Rehabilitation Program to use photographs of my home for the intent of promoting its program. This includes, but is not limited to outreach programs, public hearings, and newspaper articles, city website, social media outlets, or news stations.
8. My Home Address *
10. City*
11. State*
12. Zip Code*
14. 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.
16. Homeowner's Electronic Signature*
18. NOTE:
    As the homeowner, you are under no obligation to sign this form. Pictures of your home will only be used by the City of Balch Springs with your consent.
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

* indicates a required field