Form Center

2. Customer Class*

   1. Residential
   2. Commercial
3. Start Date*
5. Service Address*
7. Name*
9. Mailing Address*
11. Phone Number*
12. Alternative Number
13. Cell Phone Number
15. Date of Birth*
16. Driver's License
17. Social Security
19. Landlord Name*
20. Phone Number
22. Email Address
24. Commercial Customer Emergency After Hours Phone Number
26. Other Information

    1. Over 65 Exemption
28. Statement Billing

    1. Yes
    2. No
29. Have you previously had service in the City of Bridgeport?

    1. Yes
    2. No
31. Certificate of Occupancy Issue Date
33. Names of Other Adults Living at the Service Address
    All adults listed on the lease agreement must be listed on the utility application.
35. Name
36. Phone Number
38. Date of Birth*
40. Name
41. Phone Number
43. Name
44. Phone Number
46. Additional Information
    Customer will be at property between 8 a.m. and 10 a.m. for services to be turned on. There will be a $25 Call Out fee charged if the Electric or Water Department has to go back out to connect services. A $100 tampering fee (per service) will be charged if anyone other than the City of Bridgeport turns a meter on/off, or tampers with a meter in any way. Services turned off for non payment will be charged a $15 service fee per utility. NSF checks or returned Bank Drafts will be charged a $30 fee and services will be disconnected upon notification from the bank. The $15 service fee per utility will be charged once services are disconnected. Bank Draft is done on the 15th of the month, unless the 15th is a weekend or holiday then it will draft the next business day. Trash days are Monday (north of Halsell,) and Tuesday (south of Halsell). Recycling is on Thursday. Brush and bulk pick up needs to be scheduled anytime of the week before Thursday at 4:30 p.m., in order for it to be picked up on Friday of that week. Brush must be bundled. Bills are sent on the 1st of the month and are always due on the 20th of the month (unless you signed up for bank draft).
48. Do you want the city to withhold your name / address from public inquiry?

    1. Yes
    2. No
50. Terms & Acknowledgement
    The undersigned hereby makes application to the City of Bridgeport for any or all the utility services offered by the City of Bridgeport (electric, water, wastewater, garbage), to be supplied at the address described herein, and upon request, at any other local address served by the City of Bridgeport to which the applicant may move. The applicant agrees to pay for said services as bills are rendered in accordance with the rates, rules, and regulations as provided in the City Ordinances, and to abide by all the rules and regulations as now existing or as may be enacted and in effect at the time of delivery. The applicant further agrees to release and discharge the City of Bridgeport from any liability for damage suffered (1) by reason of water, wastewater, or electric current furnished to the premises or (2) by reason of interruption, discontinuance, or disconnection of service from any cause other than negligence by the City of Bridgeport, or (3) by reason of condition, maintenance, location, or existence of any facilities, fixtures, or systems on or adjoining the property supplied and by which such services are furnished or delivered. The information that I have provided on this application is truthful and accurate, and the name in which the account will be listed is my right and lawful name or the name of the company I represent, and I do further understand that the false information can be grounds for denial or termination of services by the City of Bridgeport. I understand and consent to a credit check by the City of Bridgeport knowing that approval can only be made following such credit check.
Leave This Blank:


51. Print Only

* indicates a required field