Form Center

2. Contact Information
4. Company
5. Tax I.D.
7. Contact Name*
8. Contact Phone Number*
10. Email Address*
12. Meter Information
    $10.00 per 1,000 gallons used. City Staff fills out this section.
14. Beginning Reading
15. Ending Reading
17. Total Gallons Used
18. Total Amount Due
20. I understand that by obtaining bulk water from the City of Bullard, that I will be required to pay for the water that I get from the City.
22. 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.

    1. I agree.
24. Applicant Signature*
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field