Action Center / CITY OF PORTALES UTILITY BILLING DEPARTMENT APPLICATION FOR SERVICE / Portales, NM

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CITY OF PORTALES UTILITY BILLING DEPARTMENT APPLICATION FOR SERVICE

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Please fill out the following form fields.

Property managers, commercial owners and landlords call 575-356-6662

Also email or text a copy of your ID to waterbilling@portalesnm.gov

Mail your deposit to 100 West. 1^st Street Portales, NM 88130 or put it in the drop box behind city hall, please make sure all your information (Name, Address and phone number) are included in with the payment.

* Denotes a required field

FULL NAME

MARITAL STATUS

DRIVER'S LICENSE NUMBER

STATE

DATE OF BIRTH

TELEPHONE #

CELL PHONE #

EMPLOYER NAME

EMPLOYER TELEPHONE #

SPOUSE'S NAME (IF ANY)

SPOUSE'S TELEPHONE #

EMERGENCY CONTACT NAME

TELEPHONE #

PRIOR SERVICE WITH THE CITY OF PORTALES? IF SO, WHEN?

DO YOU HAVE A CURRENT SERVICE WITH THE CITY OF PORTALES?

CURRENT SERVICE ADDESS

IS THIS A TRANSFER?

Please Do Not Complete The Following Field

DISCONNECTION DATE IF TRANSFERRING

SERVICE REQUESTED AT (ADDRESS)

REQUESTED CONNECT DATE

TIMEFRAME OF 9-11 OR 1-3?

MAILING ADDRESS FOR BILLING

I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT THE INFORMATION GIVEN IS CORRECT (TYPE SIGNATURE BELOW)

Contact Us

100 W. First Street
Portales, NM 88130
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Telephone: (575)356-6662
Personnel Directory

Portales, New Mexico

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CITY OF PORTALES UTILITY BILLING DEPARTMENT APPLICATION FOR SERVICE

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