CITY OF LACY LAKEVIEW UTILITY DEPOSIT

PLEASE SUBMIT THIS FORM AND THE TCEQ AGREEMENT TO SET UP YOUR ACCOUNT

ALL NEW UTILITY DEPOSITS SUBMITTED AFTER 1 PM WILL NOT BE ELIGIBLE FOR SAME DAY TURN ON

DATE:

SERVICE ADDRESS:

ADDRESS-CITY-STATE-ZIPCODE

BILLING ADDRESS (IF DIFFERENT)

ALL BILLS WILL BE SENT TO BILLING ADDRESS IF DIFFERENT FROM SERVICE ADDRESS

NAME OF RESIDENT OR BUSINESS NAME:

RESIDENTIAL/ COMMERCIAL/INDUSTRIAL

PHONE NUMBER:

ADDITIONAL PHONE NUMBER:

Please enter a valid phone number.Format: (000) 000-0000.

EMAIL:

example@example.com

UTILITY DEPOSIT AMOUNT:

Deposit Amounts:

Residential: $250.00 Commercial/Industrial: Please Contact the Utility Office

Fire Hydrant: $300.00 Temporary: $100.00

Residential New Construction : $200.00

Turn On fee: $25.00 (included on all new deposits)

(Please call for Hotel and Multi family living facilities.)

SOCIAL SECURITY NUMBER OR TAX ID

SSN OR TAX ID IS REQUIRED

SOCIAL SECURITY NUMBER (IF TWO PEOPLE ARE LISTED ON THE UTILITY ACCOUNT)

ONLY FOR MULTIPLE RESIDENTS AT THE ACCOUNT-PLEASE SPECIFY WHICH SSN BELONGS TO WHOM

PHOTO IDENTIFICATION

Acceptable forms of identification are:-DRIVER'S LICENSE OR IDENTIFICATION CARD-US PASSPORT OR PASSPORT CARD-MILITARY IDENTIFICATION CARD

PROOF OF LEASE/HOME OWNERSHIP/RENTAL AGREEMENT

RESIDENTIAL ACCOUNTS: Proof of lease/Rental Agreement/Proof of Ownership

COMMERCIAL ACCOUNTS: Lease or Deed to the property (if you are not the owner, a letter stating that you have authority to open the account written on company letterhead)

Do you have a dog/dogs?

If you answered "yes" to this question, please fill out the Application for Pet Registration & License form. The Pet Registration fee is $5.00.

Please note: If you do not fill out this form, we cannot connect services.

Ordinance NO. 2014-01

I want my personal information kept confidential

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COMPLETION STATUS

PLEASE SUBMIT THIS FORM AND THE TCEQ AGREEMENT TO SET UP YOUR ACCOUNT