Residential Water Service Application

Utility Billing Department
418 W Henderson St.
P.O. Box 657
Cleburne, TX 76033
817-645-0919

Date*

Date

Service Address*

Mailing Address (if different from Service Address)

Street or P.O. Box

Street Address Line 2

CityState

Zip

Owner or Renter*

OwnerRenter

Newly built home?*

YesNo

Proof of Ownership*

Owners of newly built residences must provide proof of ownership or the closing document statement with the closing date.

Start Date*

Date

Account Confidentiality*

YesNo

Do you want to sign up for emergency alerts from the City of Cleburne? This will ensure you are directly notified of major events, such as boil water notices, severe weather, etc.*

Yes, please keep me alerted.No, I do not want to receive any emergency alerts.

IMPORTANT: To complete the sign-up process for emergency alerts, please visit bit.ly/CleburneAlerts and submit the brief form. This is a separate process from this water service application.

Pursuant to H.B. 872, 87th Legislature, Regular Session - Confidentiality of Government-Operated Utility Customer Information, The City of Cleburne may not disclose personal and utility usage information for government operated utility customers unless the customer requests that the government-operated utility disclose such information on an appropriately marked form or other written request for disclosure; and the city must provide notice of the customer's right to request disclosure of personal and utility usage information, along with the form to elect for disclosure, in each customer's utility bill or on the government-operated utility's website.

Name of Landlord*

Landlord's Phone #*

Please enter a valid phone number.

Lease*

Please upload a copy of your lease.

Name*

Driver's License # or ID #*

Photo ID*

Please upload a copy of the applicant drivers license or photo ID.

Birth Date*

Date

Home Phone #*

Cell Phone #*

Employer*

Work Phone #*

Email*

Add a Co-Applicant?*

YesNo

Name*

Driver's License # or ID #*

Photo ID*

Please upload a copy of the co-applicant drivers license or photo ID.

Birth Date*

Date

Home Phone #*

Cell Phone #*

Employer*

Work Phone #*

Email*

City of Cleburne Residential Service Agreement

The meter is the property of the City. Only city personnel are allowed to turn the water off or on at the meter. Customers are liable for any damage to the water meter installed at the cutomers property. It is unlawful for anyone to break, damage, tamper with, obstruct the flow of, or prevent the proper running of the water meter in any matter whatoever. Customers who may commit any of the offenses listed above will be charged a fee for water loss and a fee for any damages to the water meter and may have criminal charges filed against them. City of Cleburne, Ordinance No. 51.001-51.004; a minimum DEPOSIT of $75 plus $10.00 application fee is required before starting water service. The deposit is re-fundable after one calendar year of no late payemnts or applied to your final bill, whichever comes first.

Applicant Signature*

Co-Applicant Signature

Residential Water Service Application

Applicant Information

Co-Applicant Information