NEW SERVICE APPLICATION

Thank you for selecting BPUB as your service provider! Please fill out the form below and submit.

A BPUB Customer Service Representative will call to confirm your application and verify your information. Once confirmed, please visit our offices on 1425 Robinhood Drive to complete the application process. A representative will confirm your date for either opening a new account, connecting a new service or disconnecting your current service.


COMMERCIAL ACCOUNTS
REQUEST DATE:

SERVICE FEE: $25.00 FOR EACH SERVICE
 
1.
     SERVICE ADDRESS
 
2.
     NAME OF COMPANY
 
3.
     NAME OF CONTACT PERSON
 
4.
     TAX I.D. # OR SOCIAL SECURITY NUMBER & DRIVERS LICENSE
 
5.
     PHONE NUMBER AND/ OR FAX NUMBER
 
6.
     MAILING ADDRESS
 
7.
     LEGAL STRUCTURE OF BUSINESS (CORP., PARTNERSHIP, SOLE PROP.)
 
8.
     STATE OF INCORPORATION AND LOCATION OF HOME OFFICE
 
9.
     NAMES OF CORPORATE OFFICERS, PARTNERS, OR OWNER
 
10.
       NAME OF STOCKHOLDERS (IF SMALL COMPANY)
 
11.
       TYPE OF BUSINESS
 
12.
       AGE OF COMPANY

Please read Terms and Conditions & Texas State Sales and Use Tax before submitting any forms.