Residential Water Service Application

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Residential Water Service Application

Please correct the fields below:

PLEASE NOTE - Applications will not be processed if all of the required fields are not properly filled out or if the proper documentation is not attached.

1

Turn-on Date

 *
2

Service Address

 *
Service Address
3

Mailing Address if different from Service Address

Mailing Address if different from Service Address
4

Will you reside in the premises for which service is requested? 

 *
Will you reside in the premises for which service is requested?
5

Your relationship to Property

 *
6

If you are not the property owner, please provide the property owners name and phone number

If you are not the property owner, please provide the property owners name and phone number
7

Proof of Legal Occupancy

OWNERS - If you just purchased the home and are applying for new service, please provide a copy of the deed supplied to you by the Title Company at closing or a copy of the fully signed settlement statement.

RENTERS - If you are a new tenant establishing service, please provide a copy of your lease agreement.

PROPERTY MANAGEMENT - Please provide a copy of the management agreement.

Attachment(s) - Proof of Legal Occupancy

 *
Proof of Legal Occupancy OWNERS - If you just purchased the home and are applying for new service, please provide a copy of the deed supplied to you by the Title Company at closing or a copy of the fully signed settlement statement. RENTERS - If you are a new tenant establishing service, please provide a copy of your lease agreement. PROPERTY MANAGEMENT - Please provide a copy of the management agreement. Attachment(s) - Proof of Legal Occupancy
8

Applicant

 *
Applicant
9

Are you a Senior Citizen (65 or older)?

 *
Are you a Senior Citizen (65 or older)?
10

Have you previously lived in Hurst?

 *
Have you previously lived in Hurst?
11

If you previously lived in Hurst, please list the last 3 addresses.

If you previously lived in Hurst, please list the last 3 addresses.
12

Co-Applicant - A copy of this applicant's ID is mandatory as they will be considered co-owner of this account.

Co-Applicant - A copy of this applicant's ID is mandatory as they will be considered co-owner of this account.
13

List additional individuals authorized to speak to the City about this account on your behalf.

List additional individuals authorized to speak to the City about this account on your behalf.
APPLICANT HEREBY AGREES THAT any current or other unpaid account accrued against him/her may be
transferred to the account where service is herein applied for, or to any other account in name of
applicant. Applicant further agrees to pay all water furnished to the mentioned premises according to
the meter readings and rates prescribed by the City until this agreement is cancelled by written notice to
discontinue service filed with the City, signed by applicant or his/her agent. That the City may
discontinue water service without notice at any time and for any reason. That the City shall never be
liable to applicant or any other person or persons for any damages by water or otherwise resulting from
defective plumbing, broken or faulty service or water mains, or from any condition of the water itself or
any substance that may be mixed with or to be in the water furnished to applicant.

1. The deposit shown on the face hereof shall bear no interest.
2. Any person who has maintained a security deposit for a period of more than two (2) years
may upon written request be refunded such security deposit if a review of such individual’s
service account does not indicate that there has been any discontinuance of service due to
late payment and no more than two (2) late penalties assessed during the same period. This
provision shall NOT be applicable to multi-occupancy commercial accounts, to multifamily
dwelling units, nor to any account for which a security bond, rather than cash security
deposit has been provided.
3. Water bills must be paid on or before delinquent date shown thereon, otherwise full penalty
will be enforced.
4. In the event bills are not paid on or before delinquent date, water service may be
discontinued after written notice to consumer, and not resumed until all water bills are
paid, together with a $50.00 disconnection charge.
5. A charge of twenty-five ($25.00) shall be made for each time a city employee calls on a
customer for the purpose of discontinuing or reconnecting service.
6. The water service deposit amount will be increased by $20.00 for each instance of
disconnection for non-payment.
7. The consumer shall not sell to others or otherwise dispose of any of the service supplied
hereafter.
8. The consumer will be charged a fee of $30.00 for tampering with or cutting the locking
device put on a meter by the city.
9. In addition to other fees that apply, the city will enforce a charge of $100.00 for tampering
with a city water meter.
10. Any device found to be attached to a city meter used as a jumper device to bypass a city
water meter or in any way alter the integrity of the city’s meter will result in the consumer
to be charged a $100.00 fee.
11. In the event that the city must remove a meter from a disconnected service address due to
tampering, an additional $25.00 fee will be charged to the consumer.
12. The duly authorized agents and employees of the City shall have free access to the
consumer’s premises at all times for the purpose of installing meters and other apparatus
which the City may desire to install therein in connection with the furnishing of water
service hereunder and for the purpose of reading meters and inspecting, repairing or
removing the property of the City installed upon consumer’s premises.
14
You must agree to the City of Hurst Billing Terms and Conditions
 *
Submitting this application is effectively signing the application. All statements on this application are believed to be true and correct.
  1. To receive a copy of your submission, please fill out your email address below and submit.