ServiceRequest

SERVICE REQUEST

NOW!!!


1557 FM ROAD 1110 ▪ CLINT, TX 79836 ▪ (915)791-4480 ▪ (915)791-4498 FAX
APPLICATION DATE:
Applying by:              
Personal Information
Customer Name:
AGENT NAME (If applicable):
GENDER:                 
RELATIONSHIP:

The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in the program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of the individual applicants on the basis of visual observation of surname.


Race:


Address Details
SERVICE ADDRESS: City:
State: Zipcode:
TYPE OF OCCUPANCY: Property Owner/Rental:
SOCIAL SECURITY #: DRIVER’S LICENSE/ID#:
FEDERAL ID #: E-MAIL ADDRESS:
EMPLOYER: OCCUPATION:
HOME PHONE #: WORK #:
CELL PHONE #: MAILING ADDRESS:
       
CO-APPLICANT: SERVICE ADDRESS:
City: State:
Zipcode: SOCIAL SECURITY #:
DRIVER’S LICENSE/ID #: WORK #:
EMPLOYER: OCCUPATION:
REFERENCE NAME: RELATIONSHIP:
ADDRESS: PHONE:

SOLID WASTE GUIDELINES
●Trash collection is mandatory when you have a residential water service.
●Commercial accounts can be provided with a cart depending on the type of business.
●You will receive a 95 gallon cart for your once a week trash pick-up.
●Only the trash inside the cart will be picked-up and the lid must be closed.
●Trash cart needs to be out on scheduled day by 6:00 a.m. to avoid a missed pick-up.
●Trash carts should be at curbside on pick-up day only. Carts are your responsibility, if lost, stolen or burned, you will be charged for a replacement (The price for a cart is $45.00).
●If you have too much trash for one cart, you can request an additional cart for an additional fee.
●When you cancel service, please call to have the cart picked-up DO NOT take the cart with you or we will be obligated to charge the $45 on your final bill.
●IF YOU HAVE ANY QUESTIONS REGARDING YOUR TRASH COLLECTION, PLEASE CALL OUR OFFICE (915) 791-4480.

Signture
RESPONSIBLE PARTY (OWNER): DATE:
CUSTOMER SIGNATURE: DATE: