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Update Contact Information

2. Resident Name:*

   As it shows on bill

4. Resident Service Address*

   City, state, and zip not required

6. Mailing Address

   If different from service address

8. Primary Phone #*

9. Secondary Phone #

10. Utility Account No:*

12. Email Address:*

14. Electronic signature*

    By typing your name into this field this form, you understand that the information given above will be used to consider your late fee waiver request. You are agreeing that the information given to the City is correct.

15. Date*
    Date

17. Contact Us
    <ul> <li>Utility Billing: 713.662.5824</li> <li>Customer Service: 713.662.5826</li> <li>Direct Link: 713.662.5860</li> </ul>

    • Utility Billing: 713.662.5824
    • Customer Service: 713.662.5826
    • Direct Link: 713.662.5860

21. Date Received
    Date Received

22. Employee

24. Account Starting Date
    Account Starting Date

25. Account Late Charge History

27. Signature

    Dave Beach, City Manager

28. Date
    Date

30. Signature

    Katherine DuBose, Finance Director

31. Date
    Date

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field