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Disconnect Utility Service Application

  1. The City of Bullard Utility business hours are Monday-Friday 8AM-4PM. When requesting your disconnect date, please select a date that falls on a weekday. Requests for Saturday and Sunday will automatically be scheduled for the following Monday or next available working day. We normally offer same day service as long as your request is submitted prior to 3:30 PM on that day. However, we appreciate as much advance notice as possible.
  2. Authorized Disconnect
  3. *Your security deposit on file will be applied to your final bill. If your final bill shows a credit balance, a check will be issued from our finance department and will be mailed within 60 days of the final bill date.*
  4. I authorize the City of Bullard to discontinue utility service and refund any deposit on file. I understand that I relinquish as of the disconnection date all customer and water rights, until at such time I wish to pay a new deposit.
  5. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  6. Leave This Blank:

  7. This field is not part of the form submission.