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2. Utility Billing Customer Information Update
   In order to better serve our City of White Settlement customers we are requesting updated contact information. We have updated our services available to customers and adding email addresses to our customer profiles will allow for new notifications for customers. An updated phone number will allow for better contact with customers. Please complete and submit the form below if you would like us to be able to provide these additional forms of communication.
4. Customer Address*
6. City*
7. State*
8. Zip Code*
10. Name on Customer Account (Person Listed on Bill)*
12. Phone Number*
13. Email Address*
15. Date of Birth*
16. Water Account #*
18. Additional Person Authorized on Account Information
    In order to talk to a person not listed above we must be given authorization from the account holder to add another person to the account. Please provide the information for any additional person you would like to have access to discuss the account with the City.
20. Additional Authorized Person's Name
22. Phone Number
23. Email Address
25. Date of Birth
26. Relationship to Customer
28. Digitally sign by typing in your name*
Leave This Blank:


30. Submit

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