Home Services Application for City Services online form online form Edit Form APPLICATION FOR CITY SERVICES Do you want a Residential or Commercial Account?* Residential Commercial Name on Account* Legal Name of Business or Entity (DBA) Mailing Address – Number & Street* City, State Zip* Telephone #* Physical Address* Driver’s License # & State* Social Security # or TIN Date of Birth* Email Address Place of Employment Work Phone Spouse's Name Spouse's DL # Spouse's Social Security # or TIN Emergency Contact Name Emergency Contact Phone # Services available are determined by the physical address. Services the City of Dumas provide are gas, water, sewer and refuse/trash collection. Attach a copy of your Driver's License and Social Security Card or TIN.* We will run a soft credit check on your information and then call you with the deposit amount required. If you would like to pay by check or cash, please bring your payment to City Hall, 124 W. 6th Street, Dumas, TX 79029. If you would like to pay your deposit by credit card, please fill out the information below. We will then run the card at City Hall and have your receipt available there or email you a receipt if you input your email address below. Full Name on Credit Card Credit Card Type Visa Mastercard AMEX Discover Credit Card Number Expiration Date Security Code (Three Digits on Back of Card)? Billing Zipcode for Card BY CLICKING THE SUBMIT BUTTON, I AM CONFIRMING I GIVE THE CITY OF DUMAS PERMISSION TO RUN A SOFT CREDIT CHECK IN ORDER TO DETERMINE THE REQUIRED DEPOSIT FOR UTILITIES. IF I HAVE FILLED IN THE CREDIT CARD INFORMATION, I AM AUTHORIZING THE CITY OF DUMAS TO CHARGE THE APPROPRIATE DEPOSIT TO THAT CREDIT CARD ONCE I KNOW AND AGREE TO PAY THE DEPOSIT AMOUNT. Signature (please type your name to sign)*? Date* Customer's right to request disclosure? I DO NOT want my information disclosed. I want my information disclosed.