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2. City of Pilot Point Commercial Application for Utility Services
   Please complete the following application to have services connected or transferred.
4. Today's Date*
   Today's Date
5. Service Start Date*
   Service Start Date
   Service calls are made between 3:00PM-5:00PM on the requested start date. It is REQUIRED that someone be at the residence at the time of connection due to the possibility of an outlet being open. An open outlet can cause flooding of the premises.
7. Service Address*
9. ***Please See Planning Department upon requirement of Certificate of Occupancy***
11. Primary Contact
13. Name of Business
15. Owner First Name*
16. Owner Last Name*
18. Phone Number*
19. Work Number
21. Email Address
22. Mailing Address

    1. Yes
    2. No

    Is your mailing address the same as your service address?
24. Mailing Address
26. Bill Delivery*

    1. Mail Only
    2. Email Only
    3. Both Mail and Email

    How would you like to receive your monthly utility bill?
27. Photo Identification
    Please submit a copy of your driver license by fax to 940-686-4338, or drop off at City Hall 102 E. Main St., Pilot Point TX, 76258.
29. Transfer

    1. Yes
    2. No

    Would you like to transfer service from another location in Pilot Point?
30. Transfer of Service Address
    Please provide the service address for the account you would like to transfer from.
32. Service History *

    1. Yes
    2. No

    Have you previously had service in the City of Pilot Point?
33. Previous Service Address
    Please provide the service address for any account you have had with the City of Pilot Point.
35. Secondary Contact
37. First Name
38. Last Name
40. Phone Number
41. Work Number
43. Email Address
45. Emergency Contact
47. First Name*
48. Last Name*
50. Phone Number*
51. Work Number
53. Email Address
55. Would you like to set up Auto Payment?*

    1. Yes, I would like to set up Auto Payment
    2. No
57. Automatic Draft Form
    Automatic Draft Form
59. Confidential Request

    1. I hereby request confidentiality of my personal information by the City of Pilot Point's Utility Billing Division
    2. I hereby withdraw my request for confidentiality
61. Customer Signature*
    By signing above, I agree to applicable service connect fees and understand my monthly bill is due on or before 5:00 PM on the 5th of every month. Payments received after 5:00 PM on the 5th will incur a 10% late charge fee. Payments received after the 15th of the month are subject to disconnection and applicable fees. See service agreement for service fee amounts and additional charges and fees for service.
62. Applicant Type*
    -- Select One --OwnerBuilder
64. Customer Signature*
    I have read and understand the City of Pilot Point Service Agreement and Terms of Service Agreement.
66. City of Pilot Point Service Agreement
    Please Click Here to Read the Service Agreement
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit Submit and Print

* indicates a required field