Form Center

2. Application Date*
3. Date of Service*
5. Applicant Information
7. Building Company
9. Last Name*
10. First Name*
11. SSN*
13. Drivers License/State*
14. Date of Birth*
15. Employer
17. Email*
18. Primary Phone*
19. Secondary Phone
21. Co-Applicant Information

    Please select which option applies: 

    Co-Applicant____     Spouse_____

    Your spouse is NOT presumed to be a co-applicant. They MUST be added and present an ID with application. No information will be shared unless they are on the application.

23. Last Name
24. First Name
25. SSN
27. Drivers License/State
28. Contact Number
29. Relationship
31. Service Location Information

    1. New Account
    2. Irrigation Account
    3. Transfer Account

    1. Own
    2. Renting

    1. Residential Account
    2. Commercial Account

    (Check all that apply)

33. Service Address*
35. Mailing Address
    (If different from above)
37. If Renting
39. Landlord Name
40. Landlord Address
41. Landlord Phone Number
43. Information About the Applicant
45. Previously had City of Bullard Utility services?*
46. If yes, under what name?
47. Prior Service Address?
49. If Transferring

    A $25.00 service fee will be added to the new account.

51. Old/Current Service Address
52. Current/Prior Account Number
53. Date to terminate
55. Account Deposit*

    1. Online

    1. CC over the phone

    1. In person at City Hall

    The City of Bullard requires that every customer pay a deposit of $150.00 plus a service fee of $25.00 upon opening or re-establishing an account.

57. Trash Services

    Trash services are $17.98 plus tax which includes one poly cart and $23.00 plus tax for two poly carts. Additional poly carts will be charged on your utility bill each month at a rate of $5.02 plus tax per poly cart.

58. Number of Polycarts Needed*
60. About your deposits
    The City of Bullard requires that every utility customer pay a deposit upon opening or re-establishing an account with the city to guarantee payment on the account for water, sewer, and solid waste services rendered. A deposit is required for every location serviced by the City. Therefore, customer pays the deposit with the express understanding and agreement that the city may apply all or any part of the deposit towards an arrearage on the account ins satisfaction of the amount owed. Deposits are refunded to the customer upon closing an account. The City will refund the deposit less any amount owed to the City. The refund is paid by check and is mailed within 30-60 days of the final meter reading on the account. The customer is responsible for providing the forwarding address to the City.
62. Disconnection Policy
    The City of Bullard utility services are subject to disconnection and the 1st of the month for non-payment, accrual of 10% late payment charge and re connection fees.
64. Agreement
    I (applicant/co-applicant) hereby request the City of Bullard to provide utility services at the above location. I (applicant/co-applicant) agree to pay all charges for services rendered as a result of this request. I (applicant/co-applicant) understand and agree that failure to pay any amount due to the City can result in services not being connected/reconnected until such payment has been received.
66. 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.
68. Applicant Signature*
70. Co-Applicant Signature*
Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit Submit and Print

* indicates a required field