Public Safety and Critical Infrastructure Request Form

Public Safety and Critical Infrastructure Request Form

If you have questions about this form, please call Boerne Utilities at (830) 248-1538.
Customer Account Number
Account Holder

First NameLast Name
Customer or Authorized Representative Name (if different from account holder)

First NameLast Name
Customer or Authorized Representative Title
Customer or Authorized Representative Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Customer or Authorized Representative Email
example@example.com
Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different than Service Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PWS Number
Meter Number
Latitude/Longitude Coordinates
Detailed description of need for Critical Facility designation.
Terms and Conditions

I have read and understood the terms and conditions for the City of Boerne Critical Facility designation. I certify that the information provided on this application is correct and understand it will be used to determine eligibility for Critical Facility designation.
I agree to the Terms and Conditions
Should be Empty: