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Over 65 Discount Application

  1. Service Address:

  2. If applicable

  3. Co-applicant's Name:

  4. Note: This discount for water, sewer, and garbage will be given on the next billing following receipt of the application. The discount will not apply to any billing prior to the date the application is received by the City. Please attach a copy of "proof of age" by submitting a valid United States driver's license, identification card, passport, or Mexico Matricula Consular.

  5. My name is ____________________________________________. I am 65 years of age and the address above is my residence. I understand that the discount is only for senior citizen residents over 65 years of age, with singlefamily water, sewer, and garbage services in their name, whether owner or non-owner. 

  6. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  8. This field is not part of the form submission.