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2. 
4. Authorization to Make Changes
6. Current Account Holder:
7. Date:
9. Service Address:
10. Account Number:
14. Change of Address:
    I hereby request and authorize the City of Fate to change my mailing address. A copy of a drivers license or ID is required, this can be provided in office, emailed, faxed, mailed or in the drop box.
15. Effective Date:
17. Old Mailing Address:
19. New Mailing Address:
23. Add Additional Account Holder:
    I hereby request and authorize the City of Fate to add the following name to my utility account. A copy of the current and additional account holder's drivers license or ID is required, these can be provided in office, emailed, faxed, mailed or in the drop box.
25. New Account Holder Name:
26. Drivers License Number:
28. Social Security Number:
29. Phone Number:
31. Additional Account Holder's Signature:
32. Current Account Holder's Signature:
38. Internal Use Only
40. Date: _____________________
41. Received by: ____________________
45. Phone: 972-771-4601 Opt 2

46. Email: [email protected]

47. Fax: 972-722-8266
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field