CITY OF UNIVERSITY PARK

APPLICATION FOR WATER UTILITY SERVICE

TODAY’S DATE________________

TYPE OF PROPERTY:
Residential _______ If yes, do you…Own_______ Lease_______
Commercial_______ Commercial customers: please contact our office for deposit
information.

REQUESTED CONNECTION DATE___________

(Monday-Friday Only)

ACCOUNT NAME:_____________________________________________

SERVICE ADDRESS:___________________________________________

MAILING ADDRESS:___________________________________________

CITY:_________________ STATE:_________ ZIP:___________

DRIVER’S LICENSE NUMBER AND STATE:________________________

HOME PHONE:________________ WORK PHONE:_______________

CELL PHONE: _________________ EMAIL:_______________________

DRIVERS LICENSE NO:____________

DOES THE HOUSE HAVE AN ALARM SYSTEM?:__________

If yes, are you interested in receiving information from the University Park Police
Department regarding Direct Alarm Monitoring?___________________

The deposit will be kept on your account until the account is closed. The deposit will
then be applied to the final bill.

Deposit for Service: Own/Purchase $50.00

Lease $80.00

Commercial customers please contact Utility Office at 214.987.5322 for deposit info.

The City of University Park has the right to verify all information provided on this
application. The City of University Park is allowed by the Texas Utility Code to require
this information prior to starting service.

***I hereby make application for utility service subject to the Ordinances and
Regulations of the City of University Park.

Signature:_____________________________________Date:_____________________
 DEPOSIT PAYMENT OPTIONS

Complete this form and mail with check or money order to:
City of University Park
Utility Billing Office
3800 University Blvd
University Park, TX 75205
Office Phone: 214.987.5322
Fax Number: 214.987.5324

Charge deposit to credit card: VISA/MC/AMEX/DISCOVER

Amount: ________________________________
Card Number:___________________________________
Expiration Date:__________________ **3 or 4 Digit Verification Code:________
Credit Card Billing Address:_______________________________________________
Signature:______________________________________

**3 digit code located on end of signature line on Mastercard, Visa, or Discover
4 digit code located on front of American Express below expiration date

Pay deposit in person at City Hall: Monday - Friday

8:00am - 5:00pm

Relinquish deposit from previous accountholder. The relinquishment of deposit

from active customer to new customer is accomplished when the active customer
agrees to allow new occupant to have their deposit. Active customer must complete
and sign this form. Applicant must bring, mail, or fax to the Utility Billing
Department in City Hall along with application for service.

RELINQUISHMENT OF DEPOSIT

Current Customer: _______________________________Account #_______________

(Please Print)

Address: _________________________________________

New
Customer:___________________________________Phone:_____________________

This is to authorize the City of University Park to transfer the security deposit on my
account. I also realize that any claim to this deposit will be null and void upon signing
this document.

Customer Signature: __________________________________

Date: ____________________