Billing Authorization Agreement

2032 East Hickory Hill Road Argyle, Texas 76226
Phone: (940) 584-0780 | Fax: (940) 584-0781
www.crosstimberswater.com

  Date (Required) Your Name (required) Account # (required) Your Address (required) Your Email (required) Home Phone # (required) work Phone # (required)

I hereby authorize CROSS TIMBERS WATER SUPPLY CORPORATION (CTWSC) to send the bills on my account to the person and address below:

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Name (required) Billing Address (required) Your Email (required) Home Phone # (required) work Phone # (required)

By signing this application, the applicant acknowledges that:
I understand that CROSS TIMBERS WATER SUPPLY CORPORATION will bill the renter/lessee named above for water service as a third party, but I, as the Member, am fully responsible for any and all unpaid bills left by the renter/lessee. I shall take responsibility for any necessary deposits from the renter/lessee to ensure payment of a past due bill. Should this account become delinquent, water service will be subject to termination under the policies of the Corporation, and shall not be reinstated until all debt to the Corporation has been paid. The Corporation will notify me, the Member, of the renter/lessee’s past due account status subject to disconnection of service.
I understand that I must sign a new Billing Authorization each time I want the billing changed. If the person authorized to receive the billing notifies the Corporation to take a final reading, the billing will automatically revert back to me.
Digital Signature - Type Name Below (required) Date (Required)