Commercial New Service Application

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Please correct the field(s) marked in red below:

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For problems or inquiries please contact 281.652.1603.

1
Service Start Date
 *
2
Requested By
Requested By
3

Service Holder

Service Holder
4

Name of Business
Exactly as shown on Active DBA/Incorporation Documents.

5

Service Address

6

Mailing Address

7

City

8

State

9

Zip Code

10

Business Phone Number

11

Emergency Phone Number

12

Owner or Manager of Business

Owner or Manager of Business
13

Driver's License Number

14

Home Address

15

Home Telephone Number

16

Accounts Payable Address

17

Accounts Payable Phone Number

18

Does your business require

Does your business require
19

I understand that a deposit and connection fee will need to be paid before service can start. Please contact us at 281.652.1603 to pay these fees by credit card or debit card.

 *
20

I request the above information be kept confidential

I request the above information be kept confidential

I do hereby understand the attached terms and conditions, and accept and take full personal civil liability and responsibility for delinquent utility bills due the City of Pearland for services provided at the above mentioned address.

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