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Resident Name:*
As it shows on bill
Resident Service Address*
City, state, and zip not required
Mailing Address
If different from service address
Primary Phone #*
Secondary Phone #
Utility Account No:*
Email Address:*
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.
Date*
Date
Contact Us
- Utility Billing: 713.662.5824
- Customer Service: 713.662.5826
- Direct Link: 713.662.5860
Date Received
Date Received
Employee
Account Starting Date
Account Starting Date
Account Late Charge History
Signature
Dave Beach, City Manager
Date
Date
Signature
Katherine DuBose, Finance Director
Date
Date