City of Jacksboro Texas Online Form Center

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WHOLESALE WATER APPLICATION

  1. By completing this application, I acknowledge and understand that failure to pay the water bill by the due date will subject my account to a late fee of 10%. If not paid within 15 days after the due date, I understand that my privileges of loading water will be terminated and I or the company will not be allowed to load any additional water until payment of all charges and service fees, if any, are paid in full. (Utility Ordinance No. 0-08-03, Schedule IV). I further understand that it is my (or the authorized driver's) responsibility to complete the loading tickets in full when water is loaded at the Bulk Water Station. Failure to complete any portion of a load ticket is no excuse for non-payment. 

    By clicking "I AGREE", you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature. *

  2. VERIFICATION*

    Verification of Statement and information stated above.

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