Has your contact information changed? Did you get a new phone number, job or would you like to change your mailing address? If so, fill out this form and we'll be glad to update your information. When finished, click the submit button. Thank you for updating your information with the City of Rowlett Utility Billing and Collection Department.

Primary Account Holder Information:

First Name*

Middle Name

Last Name*

Account Number

Driver's License / Issuing State*

Attach copy of license here:*

Convert to PDF?
(GIF, JPG, JPEG, PNG, DOC, DOCX, XLS, XLSX, TXT)

Date of Birth
(mm/dd/yyyy)*

Email Address

Phone (primary)

Phone (secondary)

Place of Employment

Other Responsible Party (Spouse/Roommate):

First Name

Middle Name

Last Name

Drivers License / Issuing State

Attach copy of license here:

Convert to PDF?
(GIF, JPG, JPEG, PNG, DOC, DOCX, XLS, XLSX, TXT)

Date of Birth
(mm/dd/yyyy

Emergency Contact Information:

First Name

Last Name

Phone (Primary)

Phone (Secondary)

Service Address:

House Number*

Street Name*

Street Suffix

Billing Address (if different than service address):

House Number

Street Name

Street Suffix

City

State

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip

Additional Comments:

Terms and Conditions:

By selecting the “I AGREE” option at the end of this Utility Service Agreement, you are agreeing that this is your electronic signature that is adopted by you as your signature.

Choose one:*

I AGREE

I DO NOT AGREE

Office use only