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Application for Utility Services

  1. Applicant's Information

  2. (Any spouse, domestic partner, or adult roommate of the Primary Applicant must be identified)

  3. List the address you would like services turned on at.

  4. Provide your mailing address (if different) then your service address.

  5. The Service Address Is:*

    If the type of service address is not listed below please use the next area to provide that information. Use this area to identify the landlord, if need be.

  6. Account Information

  7. Select Type of Service Account:

  8. Does the service account have an OSSF (Onsite Sewage Facility/Septic Tank)

  9. Please choose a day that is between Monday and Friday.

  10. How would you prefer your statement to be sent to you?*

  11. If you would like to sign up for e-billing, please provide the e-mail address you would like the bill sent to.

  12. Additional Information

  13. Have you ever had service in the City of Robinson before?*

  14. Have you ever had your water service cut-off for non-payment or delinquent payment of your bill at any previous address where you have lived (if you or your spouse were the customer on the account?)*

  15. Provide two addresses where you have lived during the past five (5) years:

  16. A copy of your driver's license must be submitted with your application before service can begin.

  17. A copy of your lease agreement must be submitted with your application before service can begin.

  18. This application must be submitted and a down payment must be received before services will be connected. The down payment can be cash, check, or money order which can be mailed or made in person. Do you acknowledge this?*

    Contact the Utilities Department with any questions at (254) 662-1415 or by e-mailing

  19. In accordance with HB859, I want my personal information on my account records kept confidential.

  20. Office Use Only

  21. Company/Utility Service Application Form

  22. Leave This Blank:

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