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3. Information for the Initiation of Water Service/Trash Service
5. Last Name
6. First Name
7. Middle Initial
9. Address1
11. Billing Address if Different
13. City
14. State
15. Zip
17. Social Security Number
18. Driver's License/Date of Birth
    Number, Exp. Date, DOB
20. Daytime Phone Number
21. Other Phone
23. Service Start Date
    Water is turned on Monday - Friday Only
25. Have you had service with the City of Wichita Falls before?
27. Attach picture of ID*
    Application can not be processed without ID
29. Please Include: 1. The complete application form. 2. A copy of your driver's license. 3. Deposit must be paid in advance. 4. Completed application and deposit must be received by 4:30 PM for same business day service.
31. Mail to: City of Wichita Falls P.O. Box 1440 Wichita Falls, Texas 76307-7532
32. Fax to: (940) 761-8879

33. Deposits: Single-Family: $100.00,  Multi-Family: $75.00, Business: $110.00.

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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field