New Service Application

Please complete this form to apply for a new service. Information on this application will be used for the purpose of a credit check. Depending upon the results to your credit check, you may be required to pay a deposit in full, prior to electric service being connected.

Application Submitted Date: *

Please enter today's date

Date Service Desired: *

Please enter the date you wish your electric to begin.

Type of Request: *

Residential

Commercial

Applicant First Name: *

Enter your first name here.

Applicant Last Name: *

Enter your last name here.

Applicant Middle Initial:

Phone: *

Enter the best number to contact you, including area code

E-mail:

Enter the best e-mail address to contact you

Confirm E-mail:

Driver's License: #

Enter your valid Driver's License number here.

Date of Birth: *

Enter the date you were born.

Employer: *

Enter who you are currently employed by.

Employer Address: *

If Rent, Name of Landlord:

Landlord Address:

Billing Address: *

Please enter the street address where service is required:

Additional Name:

Enter spouse or additional responsible adult

Additional Phone:

Driver's License: #

Additional DOB:

Select date of birth for spouse or additional responsible adult

Additional Employer:

Enter employer for spouse or additional responsible adult

Additional Employer Address:

Enter the address of your spouse's or additional responsible adult's employer

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New Service Application

Account Services